Provider Demographics
NPI:1811022999
Name:WANG, SONG CHERNG (MA)
Entity Type:Individual
Prefix:DR
First Name:SONG CHERNG
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MA
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:CHERNG
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1033 W DUARTE RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7483
Mailing Address - Country:US
Mailing Address - Phone:626-641-5373
Mailing Address - Fax:
Practice Address - Street 1:9353 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1934
Practice Address - Country:US
Practice Address - Phone:626-287-2988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23608103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical