Provider Demographics
NPI:1265196745
Name:SAMOEUN, LAYLIN
Entity type:Individual
Prefix:
First Name:LAYLIN
Middle Name:
Last Name:SAMOEUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7934 DIANA MARIE DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-2602
Mailing Address - Country:US
Mailing Address - Phone:209-851-6563
Mailing Address - Fax:
Practice Address - Street 1:1111 W TOKAY ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3850
Practice Address - Country:US
Practice Address - Phone:916-999-4155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health