Provider Demographics
NPI:1902373558
Name:WANG, GRACE HUEI-EN (DPT)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:HUEI-EN
Last Name:WANG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3331 BRITTAN AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-3438
Mailing Address - Country:US
Mailing Address - Phone:714-423-6669
Mailing Address - Fax:
Practice Address - Street 1:8 ENCINA
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-1846
Practice Address - Country:US
Practice Address - Phone:714-423-6669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295398225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist