1679944730 NPI number — DR. JENNY WANG PH.D.

Table of content: DR. JENNY WANG PH.D. (NPI 1679944730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679944730 NPI number — DR. JENNY WANG PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WANG
Provider First Name:
JENNY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679944730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17006 NE 100TH PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDMOND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98052-3177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 WESTLAKE AVE N STE 200 PMB 1402
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98109-6212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-460-1667
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  PY60523734 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PY60523734 . This is a "PSYCHOLOGIST LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com