Healthcare Provider Details

I. General information

NPI: 1548755580
Provider Name (Legal Business Name): ANNIE CUN ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 W MAIN ST
ALHAMBRA CA
91801-1951
US

IV. Provider business mailing address

520 S LA FAYETTE PARK PL FL 3
LOS ANGELES CA
90057-1607
US

V. Phone/Fax

Practice location:
  • Phone: 626-248-1800
  • Fax:
Mailing address:
  • Phone: 213-252-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberACSW92201
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number92201
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberACSW92201
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberACSW134138
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: