Individual provider Active NPI

Jungim Chang, LCSW

  • Clinical Social Worker
  • Los Angeles, CA
National Provider Identifier
1477616613
Registry record updated Jan 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCS23708 Issued in CA
Practice address
520 So. Lafayette Park Place
3Rd Floor
Los Angeles, CA 90057
Phone
(213) 252-2100
Fax
(213) 383-3146
NPI assigned
Dec 19, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCS23708 CA Primary

Addresses

Primary practice location

520 So. Lafayette Park Place
3Rd Floor
Los Angeles, CA 90057

Mailing address

520 So. Lafayette Park Place
3Rd Floor
Los Angeles, CA 90057
Phone (213) 252-2100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070207000159 CA Practitioner - Clinical Social Worker 7810999661 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Special Service for Groups IncGroup PAC ID 2769396886, 61 clinicians

Practice addresses (Care Compare)

1310 Wilshire Blvd
Los Angeles, CA 90017-1705
Phone (213) 483-3000

520 S Lafayette Park PL
FL 3
Los Angeles, CA 90057-5400
Phone (213) 252-2100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCS23708CAMDClinical Social Worker
23708CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Special Service for Groups, Inc. Current Accepting new patients
Special Service for Groups, Inc. CurrentSince Dec 8, 2006 Accepting new patients
Special Service for Groups, Inc. CurrentSince Dec 8, 2006 Accepting new patients

Locations

905 E 8th St
Los Angeles, CA 90021
Phone (213) 553-1800

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390435200000",
    "number": "1477616613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 SO. LAFAYETTE PARK PLACE",
            "address_2": "3RD FLOOR",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90057",
            "telephone_number": "213-252-2100",
            "fax_number": "213-383-3146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 SO. LAFAYETTE PARK PLACE",
            "address_2": "3RD FLOOR",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90057",
            "telephone_number": "213-252-2100",
            "fax_number": "213-383-3146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANG",
        "first_name": "JUNGIM",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-19",
        "last_updated": "2014-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS23708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.