Healthcare Provider Details

I. General information

NPI: 1023369261
Provider Name (Legal Business Name): HSING-AN DAISY WANG BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 EL CAMINO REAL STE 200
TUSTIN CA
92780-3605
US

IV. Provider business mailing address

333 EL CAMINO REAL STE 200
TUSTIN CA
92780-3605
US

V. Phone/Fax

Practice location:
  • Phone: 415-646-6223
  • Fax:
Mailing address:
  • Phone: 415-646-6223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-12-10004
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: