Active NPI
Kenneth Wang, PHD
- Psychologist
- Pasadena, CA
National Provider Identifier
1043761448
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY27680
- Practice address
- 180 N Oakland Ave
Pasadena, CA 91101-1714 - Phone
- (626) 304-3712
- NPI assigned
- Oct 20, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY27680 | CA | Primary |
Addresses
Primary practice location
180 N Oakland Ave
Pasadena, CA 91101-1714
Mailing address
180 N Oakland Ave
Pasadena, CA 91101-1714
Phone (626) 304-3712
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 21, 2023 through Dec 21, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY27680 | CA | MD | Psychologist |
| 27680 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476921600000",
"number": "1043761448",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "180 N OAKLAND AVE",
"city": "PASADENA",
"state": "CA",
"postal_code": "911011714",
"telephone_number": "626-304-3712"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "180 N OAKLAND AVE",
"city": "PASADENA",
"state": "CA",
"postal_code": "911011714",
"telephone_number": "626-304-3712"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WANG",
"first_name": "KENNETH",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-10-20",
"last_updated": "2016-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY27680",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.