Provider Demographics
NPI:1700187770
Name:WAN, TIMOTHY ANDREW
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ANDREW
Last Name:WAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 W JULIAN ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2719
Mailing Address - Country:US
Mailing Address - Phone:408-292-9353
Mailing Address - Fax:408-287-3104
Practice Address - Street 1:950 W JULIAN ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2719
Practice Address - Country:US
Practice Address - Phone:408-292-9353
Practice Address - Fax:408-287-3104
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor