Provider Demographics
NPI:1669605853
Name:HIRANSOMBOON, CHRISTOPHER JASON (MS)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:JASON
Last Name:HIRANSOMBOON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:HIRANSOMBOON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:2110 ARTESIA BLVD
Mailing Address - Street 2:STE B270
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3073
Mailing Address - Country:US
Mailing Address - Phone:310-365-4643
Mailing Address - Fax:
Practice Address - Street 1:915 W IMPERIAL HWY
Practice Address - Street 2:STE 150
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3835
Practice Address - Country:US
Practice Address - Phone:800-998-6329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 43758106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist