Provider Demographics
NPI:1730215062
Name:PSYCORP SOLUTIONS, INC.
Entity type:Organization
Organization Name:PSYCORP SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-CO-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SOO
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:CHUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-516-0779
Mailing Address - Street 1:1322 E SHAW AVE
Mailing Address - Street 2:STE. 410
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7918
Mailing Address - Country:US
Mailing Address - Phone:559-226-1316
Mailing Address - Fax:559-226-1315
Practice Address - Street 1:1322 E SHAW AVE
Practice Address - Street 2:STE. 410
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7918
Practice Address - Country:US
Practice Address - Phone:559-226-1316
Practice Address - Fax:559-226-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA891893104A0625X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental IllnessGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ04784ZMedicare ID - Type Unspecified