Individual
SOPHEALYTA KHEANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3722 MIDVALE AVE, PHILADELPHIA, PA 19129-1715
(432) 271-8115
Mailing address
1525 N AMERICAN ST # 306, PHILADELPHIA, PA 19122-3821
(432) 271-8115
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS046017
PA
Other
Enumeration date
07/21/2026
Last updated
07/21/2026
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