Active NPI
Tharith Vong
- Licensed Psychiatric Technician
- Stockton, CA
National Provider Identifier
1134624802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Psychiatric Technician
- License
- 40678
- Practice address
- 1212 N California St
Stockton, CA 95202-1552 - Phone
- (209) 468-0102
- Fax
- (209) 468-2380
- NPI assigned
- Mar 26, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Psychiatric Technician | 167G00000X | 40678 | CA | Primary |
Addresses
Primary practice location
1212 N California St
Stockton, CA 95202-1552
Mailing address
1212 N California St
Stockton, CA 95202-1552
Phone (209) 468-0102
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40678 | CA | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522022400000",
"number": "1134624802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1212 N CALIFORNIA ST",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952021552",
"telephone_number": "209-468-0102",
"fax_number": "209-468-2380"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1212 N CALIFORNIA ST",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952021552",
"telephone_number": "209-468-0102",
"fax_number": "209-468-2380"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VONG",
"first_name": "THARITH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-03-26",
"last_updated": "2018-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "167G00000X",
"taxonomy_group": "",
"desc": "Licensed Psychiatric Technician",
"state": "CA",
"license": "40678",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.