Individual provider · Type 1 NPI

Ken Soryadvongsa

Mental Health Counselor · San Diego, CA

NPI number 1295469930 Active

Practice location

928 Broadway
San Diego, CA 92101-5514

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

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About NPI 1295469930

Ken Soryadvongsa's National Provider Identifier is 1295469930, issued on Jul 9, 2022. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in San Diego, CA. The record was last updated on Jul 15, 2022.