Provider Demographics
NPI:1942775770
Name:KHEK, BAMPENH BOB
Entity Type:Individual
Prefix:
First Name:BAMPENH
Middle Name:BOB
Last Name:KHEK
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:BAMBPENH
Other - Middle Name:BOB
Other - Last Name:KHEK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ADMINISTRATOR
Mailing Address - Street 1:2501 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2708
Mailing Address - Country:US
Mailing Address - Phone:562-424-6105
Mailing Address - Fax:562-427-1605
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:562-427-1605
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC167129Medicaid