Provider Demographics
NPI:1790437622
Name:CHANG, SOONG OK
Entity Type:Individual
Prefix:DR
First Name:SOONG
Middle Name:OK
Last Name:CHANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 E RUTGERS DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-5116
Mailing Address - Country:US
Mailing Address - Phone:714-863-9556
Mailing Address - Fax:
Practice Address - Street 1:3501 S HARBOR BLVD STE 167
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6940
Practice Address - Country:US
Practice Address - Phone:714-557-2982
Practice Address - Fax:714-557-2336
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist