Thai Phou

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA21328 Issued in CA

Practice address

1840 N Hacienda Blvd Ste 12
La Puente, CA 91744-1143

Phone

(916) 848-5412

NPI assigned

Nov 11, 2010

Last updated

Jan 9, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Thai Phou Other name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Chanukya Dasari MD a Professional Corporation

  • Surgery Physician
  • La Puente, CA
  • NPI 1942184817
  Medicare reassignment NPD
• Inland Pacific Surgical PC

  • Surgery Physician
  • Paramount, CA
  • NPI 1063213700
  Medicare reassignment
• Professional Wound Specialists PC

  • Surgery Physician
  • Pomona, CA
  • NPI 1437988326
  Medicare reassignment
• Psychiatry and Mental Health, a Physician Assistant Corporation

  • Physician Assistant
  • Northridge, CA
  • NPI 1538044565
  Medicare reassignment
• Ming-Wei Wu, Inc

  dba Professional Wound Specialists

  • Surgery Physician
  • Las Vegas, NV
  • NPI 1699975144

  CA

  Medicare reassignment
• California Physician Consultants, PC

  • Orthopaedic Surgery Physician
  • Mission Viejo, CA
  • NPI 1013231893
  NPD (past)
• Front Line Emergency Care Spec

  • Emergency Medicine Physician
  • Lynwood, CA
  • NPI 1366451080
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1289433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767916800000",
    "number": "1023319746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1840 N HACIENDA BLVD STE 12",
            "city": "LA PUENTE",
            "state": "CA",
            "postal_code": "917441143",
            "telephone_number": "909-226-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1840 N HACIENDA BLVD STE 12",
            "city": "LA PUENTE",
            "state": "CA",
            "postal_code": "917441143",
            "telephone_number": "916-848-5412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHOU",
        "first_name": "THAI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-11-11",
        "last_updated": "2026-01-09",
        "certification_date": "2026-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "PA21328",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA21328",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THAI",
            "last_name": "PHOU",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Callandra Phan, DMD
• Huong Phan, DDS
• Timothy Phan, PHARM D
• Elbert Phang, PHARMD
• Vijay Pharar, D.D.S
• Lissette Pinedo
• Georgina Pinto, SOCIAL WORK
• Suk Yi Chloe Poon
• Sharon Lynn Porter
• Elsie Marie Pride, LMFT

• Surgical Physician Assistant in La Puente, CA
• Providers in La Puente, CA by specialty
• Surgical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.