Healthcare Provider Details

I. General information

NPI: 1629853072
Provider Name (Legal Business Name): RUOGU JASON WANG PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 CONNECTICUT AVE NW STE 400E
WASHINGTON DC
20036-1124
US

IV. Provider business mailing address

1555 CONNECTICUT AVE NW STE 400E
WASHINGTON DC
20036-1124
US

V. Phone/Fax

Practice location:
  • Phone: 202-596-7388
  • Fax:
Mailing address:
  • Phone: 202-596-7388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY200001766
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: