Healthcare Provider Details

I. General information

NPI: 1336559798
Provider Name (Legal Business Name): KHAT RAE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W GABILAN ST
SALINAS CA
93901-2762
US

IV. Provider business mailing address

1318 JUDSON ST # A
SEASIDE CA
93955-5555
US

V. Phone/Fax

Practice location:
  • Phone: 831-758-0181
  • Fax:
Mailing address:
  • Phone: 831-393-9867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: