Provider Demographics
NPI:1255958765
Name:KHONG, CHARLIE (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLIE
Middle Name:
Last Name:KHONG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3351 E HILL ST
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-1219
Mailing Address - Country:US
Mailing Address - Phone:562-938-7665
Mailing Address - Fax:562-684-4173
Practice Address - Street 1:3351 E HILL ST
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-1219
Practice Address - Country:US
Practice Address - Phone:562-938-7665
Practice Address - Fax:562-684-4173
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor