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General NPI Number Information
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NPI Number | 1669605853
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Entity Type | Individual
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Provider Name | CHRISTOPHER JASON HIRANSOMBOON M.S.
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Gender | Male
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Dates
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Enumeration Date | 09/03/2009
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Last Update Date | 09/03/2009
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Provider Practice Location Address
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Address Line | 915 W IMPERIAL HWY STE 150
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City | BREA
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State | CA
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Zip | 92821-3835
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Country | US
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Telephone | 800-998-6329
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Fax |
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Provider Business Mailing Address
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Address Line | 2110 ARTESIA BLVD STE B270
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City | REDONDO BEACH
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State | CA
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Zip | 90278-3073
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Country | US
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Telephone | 310-365-4643
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 43758
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License Number State | CA
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