Individual
KUNTHY PRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1082 REDONDO AVE, LONG BEACH, CA 90804
(562) 434-4457
(562) 434-4458
Mailing address
1082 REDONDO AVE, LONG BEACH, CA 90804
(562) 434-4457
(562) 434-4458
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A39667
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A396670
—
CA
Enumeration date
09/22/2006
Last updated
07/08/2007
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