Doctor Name: | SUK CHOO CHANG |
NPI Number: | 1144248329 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | MD00054884 |
Business Practice Address: | 2821 Mission Hill Road Tulalip, WA - 98271 |
Business Phone Number: | 3607164400 |
Business Fax Number: | 3606514404 |
Mailing Address: | 2821 Mission Hill Rd, TULALIP |
State: | WA |
Postal Code: | 982719706 |
Phone Number: | 3607164400 |
Fax Number: | |
NPI Enumeration Date: | 07/17/2006 |
NPI Last Update Date: | 07/14/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MD00054884 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |