Provider Demographics
NPI:1427001254
Name:WEN, JOHNNY H (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:H
Last Name:WEN
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 1:3858 W CARSON ST STE 121
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-6705
Mailing Address - Country:US
Mailing Address - Phone:310-540-4094
Mailing Address - Fax:424-201-5707
Practice Address - Street 1:3858 W CARSON ST STE 121
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-6705
Practice Address - Country:US
Practice Address - Phone:310-540-4094
Practice Address - Fax:424-201-5707
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20796103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical