Provider Demographics
NPI:1417076605
Name:KAN, WEN-TING MICHELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:WEN-TING
Middle Name:MICHELLE
Last Name:KAN
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 1:4760 MAHOGANY ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-7672
Mailing Address - Country:US
Mailing Address - Phone:925-238-8932
Mailing Address - Fax:
Practice Address - Street 1:4695 CHABOT DR STE 200
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2756
Practice Address - Country:US
Practice Address - Phone:925-336-3489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003011101YM0800X
CA31953103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health