Provider Demographics
NPI:1548415722
Name:CHIEMBANCHONG, JOY SUPARUX
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:SUPARUX
Last Name:CHIEMBANCHONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4645 E ANAHEIM ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3122
Mailing Address - Country:US
Mailing Address - Phone:562-365-2020
Mailing Address - Fax:562-239-3135
Practice Address - Street 1:4645 E ANAHEIM ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3122
Practice Address - Country:US
Practice Address - Phone:562-365-2020
Practice Address - Fax:562-239-3135
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist