MEDICARE: CHRISTINE KHANH HILL ASW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	97639	CA

General Provider Information

NPI Number	:	1225623960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE KHANH HILL ASW

Provider Business Mailing Address
First Line	:	26910 TRESTLES DR
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91351-2825
Country	:	US
Telephone Number	:	310-977-5830
Fax Number	:

Provider Business Practice Location Address
First Line	:	1711 W TEMPLE ST STE 5658
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-7337
Country	:	US
Telephone Number	:	323-543-4535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2021
Last Update Date	:	03/04/2021

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