Healthcare Provider Details

I. General information

NPI: 1346499019
Provider Name (Legal Business Name): KHANH NGOC BAO HUA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E IMPERIAL HWY
LA HABRA CA
90631-7463
US

IV. Provider business mailing address

601 E IMPERIAL HWY
LA HABRA CA
90631-7463
US

V. Phone/Fax

Practice location:
  • Phone: 714-644-6480
  • Fax:
Mailing address:
  • Phone: 714-644-6480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC52191
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number52191
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: