Healthcare Provider Details

I. General information

NPI: 1801444930
Provider Name (Legal Business Name): SHUCHANG KANG PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2019
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 WESTWOOD PLAZA
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

14271 JEFFREY RD # 274
IRVINE CA
92620-3405
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-0768
  • Fax:
Mailing address:
  • Phone: 949-431-6610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number32045
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: