Healthcare Provider Details

I. General information

NPI: 1841166030
Provider Name (Legal Business Name): PAIWEN WANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W FOOTHILL BLVD UNIT A
SAN DIMAS CA
91773-1103
US

IV. Provider business mailing address

637 N MENTOR AVE APT 203
PASADENA CA
91106-1065
US

V. Phone/Fax

Practice location:
  • Phone: 626-507-3585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number157342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: