Individual provider Active NPI

Jessica Wang, DO

  • Psychiatry Physician
  • Claremont, CA
National Provider Identifier
1528588555
Registry record updated Aug 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
20A18814 Issued in CA
Practice address
675 W Foothill Blvd Ste 200
Claremont, CA 91711-3475
Phone
(925) 282-1778
Fax
(415) 296-5299
NPI assigned
Jun 21, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 23, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X OT018118 PA
Psychiatry Physician 2084P0800X 20A18814 CA Primary

Addresses

Primary practice location

675 W Foothill Blvd Ste 200
Claremont, CA 91711-3475

Mailing address

675 W Foothill Blvd Ste 200
Claremont, CA 91711-3475
Phone (925) 282-1778

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240909002436 CA Practitioner - Psychiatry 9335476225 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Rowan University School of Osteopathic Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pacific Coast Psychiatric Associates IncGroup PAC ID 2567469174, 637 clinicians

Practice addresses (Care Compare)

675 W Foothill Blvd
Suite 200
Claremont, CA 91711-3475
Phone (925) 282-1778

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
20A18814CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Coast Psychiatric Associates Inc Psychiatry CurrentSince Jul 26, 2024 Accepting new patients

Locations

675 W Foothill Blvd
Ste 200
Claremont, CA 91711
Phone (909) 278-2590

4040 Barranca Pkwy
Ste 260
Irvine, CA 92604

6200 Wilshire Blvd
Ste 1410
Los Angeles, CA 90048
Phone (323) 403-0474

701 S Parker St
Ste 2800
Orange, CA 92868

490 Post St
Ste 1043
San Francisco, CA 94102
Phone (415) 409-0944

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.jessicawang@148377.advancedmd-direct.com

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1498003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724371200000",
    "number": "1528588555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 W FOOTHILL BLVD STE 200",
            "city": "CLAREMONT",
            "state": "CA",
            "postal_code": "917113475",
            "telephone_number": "925-282-1778",
            "fax_number": "415-296-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 W FOOTHILL BLVD STE 200",
            "city": "CLAREMONT",
            "state": "CA",
            "postal_code": "917113475",
            "telephone_number": "925-282-1778",
            "fax_number": "415-296-5299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANG",
        "first_name": "JESSICA",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-21",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "PA",
            "license": "OT018118",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "20A18814",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Claremont, CA

Sources for this page

Verify at the official NPI Registry.