Healthcare Provider Details

I. General information

NPI: 1902376445
Provider Name (Legal Business Name): SUN KANG LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 MAPLE AVE
LOS ANGELES CA
90014-2211
US

IV. Provider business mailing address

655 MAPLE AVE
LOS ANGELES CA
90014-2211
US

V. Phone/Fax

Practice location:
  • Phone: 310-991-1491
  • Fax:
Mailing address:
  • Phone: 310-991-1491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number102752
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4497
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLMFT127408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: