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NPI Code Detail

MEDICARE: CHANNARY VOENG

MEDICARE: CHANNARY VOENG
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
1101YM0800XMental Health Counselor
2106H00000XMarriage & Family Therapist159899CA

General Provider Information

NPI Number : 1992459911
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHANNARY VOENG
Provider Business Mailing Address
First Line : 425 E AVENUE 28
Second Line :
City : LOS ANGELES
State : CA
Zip : 90031-2027
Country : US
Telephone Number : 310-337-1550
Fax Number :
Provider Business Practice Location Address
First Line : 8616 LA TIJERA BLVD STE 200
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-3945
Country : US
Telephone Number : 310-337-1550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2022
Last Update Date : 01/09/2026

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Directions to “ CHANNARY VOENG ” Practice Location

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