Provider Demographics
NPI:1396099123
Name:KUNG, HEANH SOCHEATA (MSW)
Entity type:Individual
Prefix:MS
First Name:HEANH
Middle Name:SOCHEATA
Last Name:KUNG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 ATLANTIC AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4569
Mailing Address - Country:US
Mailing Address - Phone:562-424-1886
Mailing Address - Fax:
Practice Address - Street 1:3530 ATLANTIC AVE STE 210
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4569
Practice Address - Country:US
Practice Address - Phone:714-343-4056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34802101YM0800X
101YM0800X, 1041C0700X, 225400000X
CA880011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty