Active NPI
Tiffany Enrou Khang, LCSW
- Clinical Social Worker
- Travis AFB, CA
National Provider Identifier
1972264190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 2018036903
- Practice address
- 101 Bodin Cir
Travis AFB, CA 94535-1809 - Phone
- (707) 423-5174
- NPI assigned
- Jan 10, 2022
- Last updated
- Mar 11, 2022
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 2018036903 | MO | Primary |
Addresses
Primary practice location
101 Bodin Cir
Travis AFB, CA 94535-1809
Mailing address
101 Bodin Cir
Travis AFB, CA 94535-1809
Phone (707) 423-5174
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2018036903 | MO | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1641772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646956800000",
"number": "1972264190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 BODIN CIR",
"city": "TRAVIS AFB",
"state": "CA",
"postal_code": "945351809",
"telephone_number": "707-423-5174"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 BODIN CIR",
"city": "TRAVIS AFB",
"state": "CA",
"postal_code": "945351809",
"telephone_number": "707-423-5174"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHANG",
"first_name": "TIFFANY",
"middle_name": "ENROU",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-01-10",
"last_updated": "2022-03-11",
"certification_date": "2022-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MO",
"license": "2018036903",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Travis AFB, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.