Healthcare Provider Details

I. General information

NPI: 1679627483
Provider Name (Legal Business Name): JOHNNY H. WEN, PHD PSYCHOLOGY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3858 W CARSON ST STE 121
TORRANCE CA
90503-6705
US

IV. Provider business mailing address

3858 W CARSON ST STE 121
TORRANCE CA
90503-6705
US

V. Phone/Fax

Practice location:
  • Phone: 310-540-4094
  • Fax: 424-201-5707
Mailing address:
  • Phone: 310-540-4094
  • Fax: 424-201-5707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY20796
License Number StateCA

VIII. Authorized Official

Name: DR. JOHNNY H WEN
Title or Position: NEUROPSYCHOLOGIST
Credential: PHD
Phone: 310-540-4094