Healthcare Provider Details

I. General information

NPI: 1861279713
Provider Name (Legal Business Name): CHLOE WANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4619 ROSEMEAD BLVD
ROSEMEAD CA
91770-1478
US

IV. Provider business mailing address

1117 N ALMANSOR ST
ALHAMBRA CA
91801-1132
US

V. Phone/Fax

Practice location:
  • Phone: 626-286-1191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number22724
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: