Healthcare Provider Details

I. General information

NPI: 1477612646
Provider Name (Legal Business Name): JAIMIE SOKHENG CHOU PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAIMIE SOKHENG PICH EDD

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

879 W 190TH ST STE 720
GARDENA CA
90248-4205
US

IV. Provider business mailing address

1720 E 120TH ST
LOS ANGELES CA
90059-3052
US

V. Phone/Fax

Practice location:
  • Phone: 310-217-7312
  • Fax:
Mailing address:
  • Phone: 310-668-3959
  • Fax: 310-223-0621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY26593
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS22086
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: