Healthcare Provider Details

I. General information

NPI: 1265951396
Provider Name (Legal Business Name): SUNG HEE CHANG MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2017
Last Update Date: 09/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 5TH AVENUE, SUITE 903
NEW YORK NY
10018-1001
US

IV. Provider business mailing address

1567 JOHN STREET
FORT LEE NJ
07024
US

V. Phone/Fax

Practice location:
  • Phone: 212-633-9162
  • Fax:
Mailing address:
  • Phone: 646-241-2988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: