Provider Demographics
NPI:1306479795
Name:HSIA, JENNIFER FANG (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:FANG
Last Name:HSIA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 CORDOVA ST UNIT 385
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-4610
Mailing Address - Country:US
Mailing Address - Phone:626-372-2799
Mailing Address - Fax:
Practice Address - Street 1:595 E COLORADO BLVD STE 409
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2018
Practice Address - Country:US
Practice Address - Phone:626-540-2125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28933103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist