Provider Demographics
NPI:1629382221
Name:CHHIM, SOPHANY CHAN (OD)
Entity Type:Individual
Prefix:DR
First Name:SOPHANY
Middle Name:CHAN
Last Name:CHHIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5773 GREENBACK LN
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-2013
Mailing Address - Country:US
Mailing Address - Phone:916-863-3146
Mailing Address - Fax:916-863-3148
Practice Address - Street 1:5773 GREENBACK LN
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-2013
Practice Address - Country:US
Practice Address - Phone:916-863-3146
Practice Address - Fax:916-863-3148
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14296TLG152W00000X
AZ1765152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA111018Medicare PIN