Provider Demographics
NPI:1891035242
Name:CAMBODIAN ASSOCIATION OF AMERICA
Entity Type:Organization
Organization Name:CAMBODIAN ASSOCIATION OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KIMTHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:KUOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-988-1863
Mailing Address - Street 1:2390 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-3051
Mailing Address - Country:US
Mailing Address - Phone:562-988-1863
Mailing Address - Fax:562-988-1475
Practice Address - Street 1:2501 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2708
Practice Address - Country:US
Practice Address - Phone:562-424-6105
Practice Address - Fax:562-427-1678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190358AN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health