Provider Demographics
NPI:1578606240
Name:YI, SUNG HYE (PHD)
Entity Type:Individual
Prefix:
First Name:SUNG HYE
Middle Name:
Last Name:YI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28462 LA ALCALA
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7640
Mailing Address - Country:US
Mailing Address - Phone:714-493-7258
Mailing Address - Fax:949-215-9446
Practice Address - Street 1:1020 S ANAHEIM BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5854
Practice Address - Country:US
Practice Address - Phone:714-493-7258
Practice Address - Fax:949-215-9446
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17357103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP17357Medicare ID - Type Unspecified