Healthcare Provider Details

I. General information

NPI: 1063223956
Provider Name (Legal Business Name): WAN-JU CHAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2025
Last Update Date: 01/18/2025
Certification Date: 01/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MOORPARK AVE STE 300
SAN JOSE CA
95128-2680
US

IV. Provider business mailing address

130 DESCANSO DR UNIT 458
SAN JOSE CA
95134-1877
US

V. Phone/Fax

Practice location:
  • Phone: 408-975-2730
  • Fax:
Mailing address:
  • Phone: 504-261-0904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY35569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: