Basic Information
Provider Information
NPI: 1437226081
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SOK
FirstName: JUSTIN
MiddleName: C.
NamePrefix: MR.
NameSuffix:  
Credential: MSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5804 E GARFORD ST
Address2:  
City: LONG BEACH
State: CA
PostalCode: 908153203
CountryCode: US
TelephoneNumber: 5625227185
FaxNumber:  
Practice Location
Address1: 1975 LONG BEACH BLVD FL 2
Address2:  
City: LONG BEACH
State: CA
PostalCode: 908065501
CountryCode: US
TelephoneNumber: 5625999401
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/29/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XASW 17905CAY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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