Individual provider Active NPI

Shaune-Ru Wang

  • Counseling Psychologist
  • San Jose, CA
National Provider Identifier
1275202699
Registry record updated Dec 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
36412 Issued in CA
Practice address
2400 Moorpark Ave Ste 300
San Jose, CA 95128-2680
Phone
(408) 975-2730
Fax
(408) 975-2764
NPI assigned
Sep 9, 2021
Last updated
Dec 16, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling Psychologist 103TC1900X 36412 CA Primary
Student in an Organized Health Care Education/Training Program 390200000X NU
Rehabilitation Practitioner 225400000X NU

Addresses

Primary practice location

2400 Moorpark Ave Ste 300
San Jose, CA 95128-2680

Mailing address

2400 Moorpark Ave Ste 300
San Jose, CA 95128-2680
Phone (408) 975-2730

Other practice location 1

3626 Balboa St
San Francisco, CA 94121-2604
Phone (415) 668-5955

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260106002965 CA Practitioner - Clinical Psychologist 8022504323 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2024
Medicare assignment
May accept Medicare assignment
Group practices

Practice addresses (Care Compare)

2400 Moorpark Ave
Suite 300
San Jose, CA 95128-2680
Phone (408) 975-2763

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
36412CAMDCounseling Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Asian Americans for Community Involvement of Santa Clara County, Inc CurrentSince Dec 15, 2025 Accepting new patients
Asian Americans for Community Involvement of Santa Clara County, Inc CurrentSince Dec 15, 2025 Accepting new patients
Didi Hirsch Psychiatric Service Past Accepting new patients

Locations

2400 Moorpark Ave
Ste 300
San Jose, CA 95128
Phone (408) 975-2763

749 Story Rd
Ste 50
San Jose, CA 95122

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765843200000",
    "number": "1275202699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 MOORPARK AVE STE 300",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951282680",
            "telephone_number": "408-975-2730",
            "fax_number": "408-975-2764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 MOORPARK AVE STE 300",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951282680",
            "telephone_number": "408-975-2730",
            "fax_number": "408-975-2764"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3626 Balboa St",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941212604",
            "country_code": "US",
            "telephone_number": "415-668-5955",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WANG",
        "first_name": "SHAUNE-RU",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-09",
        "last_updated": "2025-12-16",
        "certification_date": "2025-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "CA",
            "license": "36412",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.