Most Relevant Information
Provider Data
| NPI Number: | 1003288564 |
| Provider Name: | KWONTA PHATIPHONG |
| Entity Type: | Individual |
| Taxonomy Code: | 106H00000X |
| Specialty: | Marriage & Family Therapist |
| License Number: | 96278 |
Most Important Dates
| Enumeration Date: | 10/23/2015 |
| Last Updated: | 07/21/2020 |
Provider Practice Location
2008 N GAREY AVE
POMONA
CA
917672722
Practice Location Phone/Fax
| Phone: | 9096236131 |
| Fax: |
Provider Mailing Location
PO BOX 1764
CHINO HILLS
CA
917090059
Provider Mailing Phone/Fax
| Phone: | 9096719004 |
| Fax: |