Provider Demographics
NPI:1144070749
Name:THE CAMBODIAN FAMILY
Entity type:Organization
Organization Name:THE CAMBODIAN FAMILY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VATTANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEONG
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:714-571-1966
Mailing Address - Street 1:1626 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-5148
Mailing Address - Country:US
Mailing Address - Phone:714-571-1966
Mailing Address - Fax:
Practice Address - Street 1:1626 E 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5148
Practice Address - Country:US
Practice Address - Phone:714-571-1966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251X00000XAgenciesSupports BrokerageGroup - Multi-Specialty