Healthcare Provider Details

I. General information

NPI: 1275086761
Provider Name (Legal Business Name): RANDY KHONG LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 07/21/2022
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 CRAMPTON ST
RENO NV
89502-2480
US

IV. Provider business mailing address

330 CRAMPTON ST
RENO NV
89502-2480
US

V. Phone/Fax

Practice location:
  • Phone: 775-336-3741
  • Fax:
Mailing address:
  • Phone: 775-336-3700
  • Fax: 775-336-3701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8023-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: