Provider Demographics
NPI:1659659514
Name:WANG, CRYSTAL SHIH-YUH (BS, MS-DPT)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:SHIH-YUH
Last Name:WANG
Suffix:
Gender:F
Credentials:BS, MS-DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:435 N BEDFORD DR STE 102
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4319
Mailing Address - Country:US
Mailing Address - Phone:310-385-9064
Mailing Address - Fax:310-385-9264
Practice Address - Street 1:435 N BEDFORD DR STE 102
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:310-385-9064
Practice Address - Fax:310-385-9264
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT37889225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist