Khoeun Chhan Baeza

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LMFT111805 Issued in CA

Practice address

3802 Duncan Ave
Clovis, CA 93619-5174

Phone

(559) 917-0740

NPI assigned

Nov 14, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Khoeun Sok Chhan Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1636848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636848000000",
    "number": "1487310496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3802 DUNCAN AVE",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936195174",
            "telephone_number": "559-917-0740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3802 DUNCAN AVE",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936195174",
            "telephone_number": "559-917-0740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAEZA",
        "first_name": "KHOEUN",
        "middle_name": "CHHAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-14",
        "last_updated": "2021-11-14",
        "certification_date": "2021-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "LMFT111805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KHOEUN",
            "last_name": "CHHAN",
            "middle_name": "SOK",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Leyla Mohassessy Azmoun, M.D.
• Jerrica Lee Shelby Babb
• Michael Anthony Bacallao, LMSW, LCSW
• Leslie A. Bacani, OD
• Sherie Rose Tayamen Bacarisa
• Jennifer Irene Bague, LCSW
• Karla Bague
• Jadd Essam Bahaaldin
• Jameshiah Lashea Bailey
• Rajan Singh Bains, PT, DPT

• Mental Health Counselor in Clovis, CA
• Providers in Clovis, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.