Healthcare Provider Details

I. General information

NPI: 1730029703
Provider Name (Legal Business Name): MIA JANG AMFT, APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 AVENUE I STE 204
REDONDO BEACH CA
90277-5608
US

IV. Provider business mailing address

11341 NATIONAL BLVD # 1136
LOS ANGELES CA
90064-3726
US

V. Phone/Fax

Practice location:
  • Phone: 424-903-6520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC21821
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAMFT161166
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: