Provider Demographics
NPI:1164781506
Name:HEM, SOKUNTHEAR (LAC)
Entity Type:Individual
Prefix:
First Name:SOKUNTHEAR
Middle Name:
Last Name:HEM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:
Other - Last Name:HEM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:1302 MANZANITA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-1521
Mailing Address - Country:US
Mailing Address - Phone:213-784-9529
Mailing Address - Fax:
Practice Address - Street 1:1346 FOOTHILL BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-2135
Practice Address - Country:US
Practice Address - Phone:213-784-9529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14884171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA45-5146010OtherTAX ID NUMBER