Provider Demographics
NPI:1861630022
Name:KWON, SAMANTHA ARCHUSSACHAT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:ARCHUSSACHAT
Last Name:KWON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 MORSE AVE
Mailing Address - Street 2:COMMONS BUILDING
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2135
Mailing Address - Country:US
Mailing Address - Phone:916-973-7502
Mailing Address - Fax:916-973-7320
Practice Address - Street 1:2008 MORSE AVE
Practice Address - Street 2:COMMONS BUILDING
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2135
Practice Address - Country:US
Practice Address - Phone:916-973-7502
Practice Address - Fax:916-973-7320
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22089103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical