Healthcare Provider Details

I. General information

NPI: 1154218063
Provider Name (Legal Business Name): IMPACT EMPLOYEE WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 N MAIN ST
SANTA ANA CA
92705-6639
US

IV. Provider business mailing address

PO BOX 270
WALNUT CA
91788-0270
US

V. Phone/Fax

Practice location:
  • Phone: 626-649-1756
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. WINSTON WANG
Title or Position: VICE PRESIDENT
Credential:
Phone: 626-461-3867