Basic Information
| Provider Information | |||||||||
| NPI: | 1396099123 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUNG | ||||||||
| FirstName: | HEANH | ||||||||
| MiddleName: | SOCHEATA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3530 ATLANTIC AVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908074569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624241886 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1001 E GRANT ST | ||||||||
| Address2: | A-3 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927016564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7143457616 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2012 | ||||||||
| LastUpdateDate: | 12/14/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 225400000X | N | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 101YM0800X | 34802 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.