Provider Demographics
NPI:1760835094
Name:TUON, SOPHEAK
Entity Type:Individual
Prefix:
First Name:SOPHEAK
Middle Name:
Last Name:TUON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2371 1/2 LIME AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-3230
Mailing Address - Country:US
Mailing Address - Phone:562-424-6105
Mailing Address - Fax:
Practice Address - Street 1:2371 1/2 LIME AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-3230
Practice Address - Country:US
Practice Address - Phone:562-424-6105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA157115 IV101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor