Provider Demographics
NPI:1215148549
Name:AOKI, WAYNE T (PHD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:T
Last Name:AOKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 DOLORES RD
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-1743
Mailing Address - Country:US
Mailing Address - Phone:626-794-8406
Mailing Address - Fax:
Practice Address - Street 1:711 E WALNUT ST
Practice Address - Street 2:SUITE 309
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1676
Practice Address - Country:US
Practice Address - Phone:626-584-5531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7334103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical