Healthcare Provider Details

I. General information

NPI: 1619745791
Provider Name (Legal Business Name): SOSUN HA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12821 NEWPORT AVE
TUSTIN CA
92780-2711
US

IV. Provider business mailing address

2321 E 4TH ST # C153
SANTA ANA CA
92705-3861
US

V. Phone/Fax

Practice location:
  • Phone: 657-224-3788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: