Provider Demographics
NPI:1861574378
Name:PREAM, SOCHEAT OUV (LAC)
Entity type:Individual
Prefix:
First Name:SOCHEAT
Middle Name:OUV
Last Name:PREAM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 E. 65TH ST.
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-2404
Mailing Address - Country:US
Mailing Address - Phone:562-607-1233
Mailing Address - Fax:
Practice Address - Street 1:3525 FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-3031
Practice Address - Country:US
Practice Address - Phone:562-607-1233
Practice Address - Fax:562-283-3914
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7375171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist