Provider Demographics
NPI:1780875708
Name:KARNSOUVONG, SUN K
Entity type:Individual
Prefix:MR
First Name:SUN
Middle Name:K
Last Name:KARNSOUVONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12240 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-2453
Mailing Address - Country:US
Mailing Address - Phone:510-215-3481
Mailing Address - Fax:
Practice Address - Street 1:12240 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-2453
Practice Address - Country:US
Practice Address - Phone:510-215-3481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator