1477612646 NPI number — DR. JAIMIE SOKHENG CHOU PSYCHOLOGIST

Table of content: DR. JAIMIE SOKHENG CHOU PSYCHOLOGIST (NPI 1477612646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477612646 NPI number — DR. JAIMIE SOKHENG CHOU PSYCHOLOGIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHOU
Provider First Name:
JAIMIE
Provider Middle Name:
SOKHENG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYCHOLOGIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PICH
Provider Other First Name:
JAIMIE
Provider Other Middle Name:
SOKHENG
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
EDD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477612646
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1720 E 120TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90059-3052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-668-3959
Provider Business Mailing Address Fax Number:
310-223-0621

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1720 E 120TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90059-3052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-668-4272
Provider Business Practice Location Address Fax Number:
310-223-0621
Provider Enumeration Date:
12/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS22086 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: PSY26593 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: W2983D . This is a "MEDICARE GROUP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".