Provider Demographics
NPI:1407148752
Name:WONG, LI WEI (BCBA)
Entity Type:Individual
Prefix:
First Name:LI
Middle Name:WEI
Last Name:WONG
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 S MENTOR AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2936
Mailing Address - Country:US
Mailing Address - Phone:800-597-4864
Mailing Address - Fax:626-768-7785
Practice Address - Street 1:106 S MENTOR AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2936
Practice Address - Country:US
Practice Address - Phone:800-597-4864
Practice Address - Fax:626-768-7785
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-09-5203103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst