Provider Demographics
NPI:1760250963
Name:PHANG, AYOUNG (PHD)
Entity Type:Individual
Prefix:
First Name:AYOUNG
Middle Name:
Last Name:PHANG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:
Other - Last Name:PHANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1031 W 34TH ST # 304
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-4067
Mailing Address - Country:US
Mailing Address - Phone:213-357-2356
Mailing Address - Fax:
Practice Address - Street 1:1031 W 34TH ST # 304
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-4067
Practice Address - Country:US
Practice Address - Phone:213-357-2356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31465103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist