Provider Demographics
NPI:1699800268
Name:SORM, SOKHOM
Entity type:Individual
Prefix:MS
First Name:SOKHOM
Middle Name:
Last Name:SORM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2522 GRAND CANAL BLVD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-8150
Mailing Address - Country:US
Mailing Address - Phone:916-659-0882
Mailing Address - Fax:
Practice Address - Street 1:2522 GRAND CANAL BLVD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8150
Practice Address - Country:US
Practice Address - Phone:916-659-0882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator