Provider Demographics
NPI:1154474294
Name:WANG, SOPHIA J (PHD)
Entity Type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:J
Last Name:WANG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4938
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745-4938
Mailing Address - Country:US
Mailing Address - Phone:808-329-7176
Mailing Address - Fax:808-326-1279
Practice Address - Street 1:76-6225 KUAKINI HWY
Practice Address - Street 2:C-103
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3211
Practice Address - Country:US
Practice Address - Phone:808-329-7176
Practice Address - Fax:808-326-1279
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22403103TC0700X
HIPSY1104103TC0700X
HIMFT-56106H00000X
CAMFC35927106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist