Healthcare Provider Details

I. General information

NPI: 1013853555
Provider Name (Legal Business Name): DAVID WANG
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5661 MCCULLOCH AVE UNIT 104
TEMPLE CITY CA
91780-2984
US

IV. Provider business mailing address

5661 MCCULLOCH AVE UNIT 104
TEMPLE CITY CA
91780-2984
US

V. Phone/Fax

Practice location:
  • Phone: 404-414-5392
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: