Healthcare Provider Details

I. General information

NPI: 1295657179
Provider Name (Legal Business Name): YUDENG WANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 6TH ST STE 120
SANTA MONICA CA
90401-2564
US

IV. Provider business mailing address

1528 6TH ST STE 120
SANTA MONICA CA
90401-2564
US

V. Phone/Fax

Practice location:
  • Phone: 310-913-8255
  • Fax:
Mailing address:
  • Phone: 310-913-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number20804
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: