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NPI Code Detail

MEDICARE: RANGSEY CHOUM B.S.

MEDICARE: RANGSEY CHOUM B.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1811471121
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANGSEY CHOUM B.S.
Provider Business Mailing Address
First Line : 430 N PILGRIM ST
Second Line :
City : STOCKTON
State : CA
Zip : 95205-4428
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 430 N PILGRIM ST
Second Line :
City : STOCKTON
State : CA
Zip : 95205-4428
Country : US
Telephone Number : 408-466-0853
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2018
Last Update Date : 02/21/2019

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Directions to “ RANGSEY CHOUM B.S.” Practice Location

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