Active NPI
San Ta, PHARMD
- Pharmacist
- Downey, CA
National Provider Identifier
1073978482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 73504
- Practice address
- 11500 Brookshire Ave
Downey, CA 90241-4917 - Phone
- (562) 904-5511
- NPI assigned
- Dec 30, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PH60565451 | WA | |
| Pharmacist | 183500000X | 57996 | TX | |
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | RPH0015000 | OR | |
| Pharmacist | 183500000X | 73504 | CA | Primary |
| Pharmacist | 183500000X | 19179 | NV |
Addresses
Primary practice location
11500 Brookshire Ave
Downey, CA 90241-4917
Mailing address
11500 Brookshire Ave
Downey, CA 90241-4917
Other names 1
- San Souvannaleuth
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 73504 | CA | MD | Pharmacist |
| 19179 | NV | MD | Pharmacist |
| 57996 | TX | MD | Pharmacist |
| PH60565451 | WA | MD | Pharmacist |
| RPH0015000 | OR | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1451433600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686268800000",
"number": "1073978482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11500 BROOKSHIRE AVE",
"city": "DOWNEY",
"state": "CA",
"postal_code": "902414917"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11500 BROOKSHIRE AVE",
"city": "DOWNEY",
"state": "CA",
"postal_code": "902414917",
"telephone_number": "562-904-5511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TA",
"first_name": "SAN",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-12-30",
"last_updated": "2023-06-09",
"certification_date": "2023-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH60565451",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "57996",
"primary": false
},
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "OR",
"license": "RPH0015000",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "73504",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NV",
"license": "19179",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SAN",
"last_name": "SOUVANNALEUTH",
"credential": "PHARMD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Downey, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.