Healthcare Provider Details

I. General information

NPI: 1578606240
Provider Name (Legal Business Name): SUNG HYE YI PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S ANAHEIM BLVD STE 300
ANAHEIM CA
92805-5854
US

IV. Provider business mailing address

28462 LA ALCALA
LAGUNA NIGUEL CA
92677-7640
US

V. Phone/Fax

Practice location:
  • Phone: 714-493-7258
  • Fax: 949-215-9446
Mailing address:
  • Phone: 714-493-7258
  • Fax: 949-215-9446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY17357
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: