Healthcare Provider Details

I. General information

NPI: 1972710416
Provider Name (Legal Business Name): SUNG WHAN CHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 FORBES AVE
PITTSBURGH PA
15219-5111
US

IV. Provider business mailing address

7076 BENNINGTON WOODS DR
PITTSBURGH PA
15237-6374
US

V. Phone/Fax

Practice location:
  • Phone: 412-232-3555
  • Fax:
Mailing address:
  • Phone: 412-366-1451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberMD069723L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: