Provider Demographics
NPI:1639571375
Name:WAN, KAYAN (PSYD)
Entity Type:Individual
Prefix:
First Name:KAYAN
Middle Name:
Last Name:WAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KAYAN
Other - Middle Name:PHOEBE
Other - Last Name:WAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:6501 N CHARLES ST # D228
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6819
Mailing Address - Country:US
Mailing Address - Phone:410-938-3461
Mailing Address - Fax:410-938-4361
Practice Address - Street 1:6501 N CHARLES ST # D228
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6819
Practice Address - Country:US
Practice Address - Phone:410-938-3461
Practice Address - Fax:410-938-4361
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014031994103TC0700X
MD06388103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical