MEDICARE: SOOKYUNG CHANG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY9462	CA

General Provider Information

NPI Number	:	1447326137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOOKYUNG CHANG

Provider Business Mailing Address
First Line	:	2911 W 8TH ST STE 201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1525
Country	:	US
Telephone Number	:	213-484-0077
Fax Number	:

Provider Business Practice Location Address
First Line	:	2911 W 8TH ST STE 201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1525
Country	:	US
Telephone Number	:	213-484-0077
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	07/08/2007

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Directions to “ SOOKYUNG CHANG ” Practice Location

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