NPIMap

Organization Active NPI

Wiltern Clinic Psychological Services, Inc.

  • Clinical Psychologist
  • Los Angeles, CA
National Provider Identifier
1891861571
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY9462 Issued in CA
Legal business name
WILTERN CLINIC PSYCHOLOGICAL SERVICES, INC.
Practice address
2911 W 8TH St Ste 201
Los Angeles, CA 90005-1525
Phone
(213) 484-0077
NPI assigned
Nov 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Sookyung ChangNPI 1447326137
Title
President
Phone
(213) 484-0077

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X PSY9462 CA Primary

Addresses

Primary practice location

2911 W 8TH St Ste 201
Los Angeles, CA 90005-1525

Mailing address

2911 W 8TH St Ste 201
Los Angeles, CA 90005-1525
Phone (213) 484-0077

National Provider Directory

National Provider Directory

Locations

626 S Kingsley Dr
Los Angeles, CA 90005
Phone (213) 484-0077

2911 W 8th St
Ste 201
Los Angeles, CA 90005
Phone (213) 484-0077

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891861571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2911 W 8TH ST STE 201",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900051525",
            "telephone_number": "213-484-0077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2911 W 8TH ST STE 201",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900051525",
            "telephone_number": "213-484-0077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILTERN CLINIC PSYCHOLOGICAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHANG",
        "authorized_official_first_name": "SOOKYUNG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "213-484-0077"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY9462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.