Healthcare Provider Details

I. General information

NPI: 1235053919
Provider Name (Legal Business Name): WEIHONG YUAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 SONYA LN
SANTA MARIA CA
93458-6322
US

IV. Provider business mailing address

4048 CEDARHURST DR APT 202
SANTA MARIA CA
93455-6419
US

V. Phone/Fax

Practice location:
  • Phone: 413-379-2635
  • Fax:
Mailing address:
  • Phone: 413-379-2635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: