Healthcare Provider Details

I. General information

NPI: 1023461720
Provider Name (Legal Business Name): MINJUN WANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 BOREL PL STE 400
SAN MATEO CA
94402-3513
US

IV. Provider business mailing address

1815 OGDEN DR APT 5
BURLINGAME CA
94010-5302
US

V. Phone/Fax

Practice location:
  • Phone: 415-429-6130
  • Fax: 855-229-3626
Mailing address:
  • Phone: 415-429-6130
  • Fax: 855-229-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: