Healthcare Provider Details

I. General information

NPI: 1255958765
Provider Name (Legal Business Name): CHARLIE KHONG D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 XIMENO AVE STE 210A
LONG BEACH CA
90804-2150
US

IV. Provider business mailing address

1650 XIMENO AVE STE 210A
LONG BEACH CA
90804-2150
US

V. Phone/Fax

Practice location:
  • Phone: 562-231-6250
  • Fax: 562-502-3516
Mailing address:
  • Phone: 562-231-6250
  • Fax: 562-502-3516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: