Provider Demographics
NPI:1891983755
Name:KHON, LARRY PHOEUN
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:PHOEUN
Last Name:KHON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 POWER INN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-6757
Mailing Address - Country:US
Mailing Address - Phone:916-383-6783
Mailing Address - Fax:
Practice Address - Street 1:5330 POWER INN RD
Practice Address - Street 2:SUITE A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-6757
Practice Address - Country:US
Practice Address - Phone:916-383-6783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor