Healthcare Provider Details

I. General information

NPI: 1639917933
Provider Name (Legal Business Name): ANTHONY KHONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8022 LA MONTE RD
STANTON CA
90680-3626
US

IV. Provider business mailing address

8022 LA MONTE RD
STANTON CA
90680-3626
US

V. Phone/Fax

Practice location:
  • Phone: 833-922-2669
  • Fax:
Mailing address:
  • Phone: 833-922-2669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: