Healthcare Provider Details

I. General information

NPI: 1235954652
Provider Name (Legal Business Name): DEREK YEE-HSIANG CHAR PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 E BONITA AVE OFC 1420
POMONA CA
91767-1923
US

IV. Provider business mailing address

255 E BONITA AVE
POMONA CA
91767-1933
US

V. Phone/Fax

Practice location:
  • Phone: 909-596-7733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY35392
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY35392
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPSY35392
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY35392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: