Provider Demographics
NPI:1649514357
Name:IP NGAN, WAI YAN (MFT)
Entity type:Individual
Prefix:DR
First Name:WAI
Middle Name:YAN
Last Name:IP NGAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:DR
Other - First Name:AGNES
Other - Middle Name:
Other - Last Name:IP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:382 N LEMON AVE # 225
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2344
Mailing Address - Country:US
Mailing Address - Phone:909-301-8801
Mailing Address - Fax:
Practice Address - Street 1:17181 GALE AVE STE C
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91745-1817
Practice Address - Country:US
Practice Address - Phone:909-301-8801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41365101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health