Individual
CHANTHOUEN PEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3830 ALVARADO AVE STE C, STOCKTON, CA 95204-2350
(209) 944-1700
Mailing address
3830 ALVARADO AVE STE C, STOCKTON, CA 95204-2350
(209) 944-1700
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
09/04/2008
Last updated
09/04/2008
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