Provider Demographics
NPI:1972710416
Name:CHANG, SUNG WHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNG
Middle Name:WHAN
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7076 BENNINGTON WOODS DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-6374
Mailing Address - Country:US
Mailing Address - Phone:412-366-1451
Mailing Address - Fax:
Practice Address - Street 1:1517 FORBES AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-5111
Practice Address - Country:US
Practice Address - Phone:412-232-3555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069723L2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0127330000Medicaid
WV0127330000Medicaid
WVD49183Medicare UPIN