Provider Demographics
NPI:1679627483
Name:JOHNNY H. WEN, PHD PSYCHOLOGY CORPORATION
Entity Type:Organization
Organization Name:JOHNNY H. WEN, PHD PSYCHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:H
Authorized Official - Last Name:WEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-540-4094
Mailing Address - Street 1:3858 W CARSON ST STE 121
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-6705
Mailing Address - Country:US
Mailing Address - Phone:310-540-4094
Mailing Address - Fax:424-201-5707
Practice Address - Street 1:3858 W CARSON ST STE 121
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-6705
Practice Address - Country:US
Practice Address - Phone:310-540-4094
Practice Address - Fax:424-201-5707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20796103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP20796Medicare ID - Type UnspecifiedPROVIDER NUMBER