Provider Demographics
NPI:1669635306
Name:KANG, SHUNG JONATHAN (PSYD)
Entity Type:Individual
Prefix:
First Name:SHUNG
Middle Name:JONATHAN
Last Name:KANG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 WILSHIRE BLVD
Mailing Address - Street 2:1024
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2307
Mailing Address - Country:US
Mailing Address - Phone:213-500-2125
Mailing Address - Fax:213-389-1760
Practice Address - Street 1:3540 WILSHIRE BLVD
Practice Address - Street 2:1024
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2307
Practice Address - Country:US
Practice Address - Phone:213-500-2125
Practice Address - Fax:213-389-1760
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21932103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical