Provider Demographics
NPI:1023369261
Name:WANG, HSING-AN DAISY (BCBA)
Entity Type:Individual
Prefix:
First Name:HSING-AN
Middle Name:DAISY
Last Name:WANG
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 EL CAMINO REAL STE 200
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3605
Mailing Address - Country:US
Mailing Address - Phone:415-646-6223
Mailing Address - Fax:
Practice Address - Street 1:333 EL CAMINO REAL STE 200
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3605
Practice Address - Country:US
Practice Address - Phone:415-646-6223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-12-10004103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst