Duangtavan Sourivong

Primary specialty

Methadone ClinicTaxonomy code 261QM2800X

Legal business name

DUANGTAVAN SOURIVONG

Practice address

3940 Home Ave
San Diego, CA 92105-5952

Phone

(619) 262-8000

NPI assigned

Oct 2, 2007

Organization subpart

No

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

Authorized official

Name

Bobby Stearns, MSW

Title

Clinic Director

Phone

(619) 262-8000

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1191283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191283200000",
    "number": "1285821389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4852 JARRETT CT",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921133598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3940 HOME AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921055952",
            "telephone_number": "619-262-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUANGTAVAN SOURIVONG",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-02",
        "last_updated": "2007-10-02",
        "status": "A",
        "authorized_official_last_name": "STEARNS",
        "authorized_official_first_name": "BOBBY",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "619-262-8000",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Simon D Du, PHARMD
• Vivian Du
• Xin Du
• Yen K Du
• Duality Within
• Jesus Eduardo Duarte Mendoza
• Brittany Duarte
• Chloe Duarte
• Dayma Duarte
• Eduardo Duarte

• Methadone Clinic in San Diego, CA
• Providers in San Diego, CA by specialty
• Methadone Clinic in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.