Ken Soryadvongsa

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

928 Broadway
San Diego, CA 92101-5514

Phone

(619) 977-3716

NPI assigned

Jul 9, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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

• Community Research Foundation Inc

  • Community/Behavioral Health Agency
  • San Diego, CA
  • NPI 1255693420
  NPD (past)
• Community Research Foundation Inc

  • Community/Behavioral Health Agency
  • San Diego, CA
  • NPI 1952328700
  NPD (past)

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

{
    "created_epoch": "1657324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657843200000",
    "number": "1295469930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "928 BROADWAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921015514",
            "telephone_number": "619-977-3716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "928 BROADWAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921015514",
            "telephone_number": "619-977-3716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SORYADVONGSA",
        "first_name": "KEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-09",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sorrento Mesa Medical Group Professional Corporation
• Sorrento Psychological Services, PC
• Sorrento Therapeutics, Inc
• Sorrento Valley Pain Relief Center
• Anna M Sorriso, PA
• Concepcion Sosa
• Loretta Sosa
• Nancy Garcia Sosa
• Robert James Sosa
• Rossanne M Sosa, DDS

• Mental Health Counselor in San Diego, CA
• Providers in San Diego, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2022; 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.