Healthcare Provider Details

I. General information

NPI: 1083583413
Provider Name (Legal Business Name): EVA C KHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E WARDLOW RD
LONG BEACH CA
90807-4628
US

IV. Provider business mailing address

850 E WARDLOW RD
LONG BEACH CA
90807-4628
US

V. Phone/Fax

Practice location:
  • Phone: 562-981-9392
  • Fax: 562-981-2622
Mailing address:
  • Phone: 562-981-9392
  • Fax: 562-981-2622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW131318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: