Healthcare Provider Details

I. General information

NPI: 1316741663
Provider Name (Legal Business Name): RICHARD TAEMOON CHONG AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 LONG BEACH BLVD STE C
LONG BEACH CA
90807-3361
US

IV. Provider business mailing address

PO BOX 6026
TORRANCE CA
90504
US

V. Phone/Fax

Practice location:
  • Phone: 562-965-1489
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT153574
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: