Individual
JASMIN KHOUNTHAVONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2051 MARENGO ST, LOS ANGELES, CA 90033-1352
(323) 409-1000
Mailing address
730 S MARENGO AVE, PASADENA, CA 91106-3886
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
95155200
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11405746
KAISER
CA
Enumeration date
02/25/2021
Last updated
02/25/2021
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