=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205715018
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVAN HUNG
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2025
-----------------------------------------------------
Last Update Date | 09/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 699 OLD ORCHARD DR
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94526-4331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-479-3914
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1079 VISTA POINTE CIR
-----------------------------------------------------
City | SAN RAMON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94582-4963
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-205-0473
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number | 220081022
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------