Provider Demographics
NPI:1891019618
Name:CHANG, SUNG AE (RPH)
Entity type:Individual
Prefix:MS
First Name:SUNG AE
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5002 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-1814
Mailing Address - Country:US
Mailing Address - Phone:718-495-1500
Mailing Address - Fax:718-492-4028
Practice Address - Street 1:5002 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-1814
Practice Address - Country:US
Practice Address - Phone:718-492-1500
Practice Address - Fax:718-492-4028
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist