Healthcare Provider Details

I. General information

NPI: 1649875527
Provider Name (Legal Business Name): SUN HYE CHANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUN HYE YIM

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 09/09/2026
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 S. LILLEY ROAD
CANTON MI
48188
US

IV. Provider business mailing address

5301 E. HURON RIVER DRIVE
ANN ARBOR MI
48106-0995
US

V. Phone/Fax

Practice location:
  • Phone: 734-398-0668
  • Fax:
Mailing address:
  • Phone: 734-619-0193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501019844
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: