Active NPI
Lucky Khambouneheuang
- Student in an Organized Health Care Education/Training Program
- San Francisco, CA
National Provider Identifier
1275201006
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 505 Parnassus Ave, M1480
San Francisco, CA 94143 - Phone
- (415) 476-1528
- NPI assigned
- Sep 6, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
505 Parnassus Ave, M1480
San Francisco, CA 94143
Mailing address
505 Parnassus Ave, M1480
San Francisco, CA 94143
Medicare participation
Medicare enrollment files- 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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240409000915 | CA | Order and Referring Only - Internal Medicine | 8729426861 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679616000000",
"number": "1275201006",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "505 PARNASSUS AVE, M1480",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "94143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "505 PARNASSUS AVE, M1480",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "94143",
"telephone_number": "415-476-1528"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHAMBOUNEHEUANG",
"first_name": "LUCKY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-09-06",
"last_updated": "2023-03-24",
"certification_date": "2023-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2023; 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.