Bounlath Kent Souksavong, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA12844 Issued in CA

Practice address

847 W Childs Ave
Merced, CA 95341-6862

Phone

(209) 383-7441

Fax

(209) 383-1643

NPI assigned

Nov 25, 2005

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1132876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1326021171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "737 W CHILDS AVE",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953406805",
            "telephone_number": "209-383-1848",
            "fax_number": "209-383-1296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "847 W CHILDS AVE",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953416862",
            "telephone_number": "209-383-7441",
            "fax_number": "209-383-1643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUKSAVONG",
        "first_name": "BOUNLATH",
        "middle_name": "KENT",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-25",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA12844",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA CERT #",
            "identifier": "1022633",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cyttirae Soto
• Jesus Soto
• Jose Manuel Soto
• Linda Soto
• Savannah Xiana Soto
• Jorge Fontes Sousa
• South Bay Emergency Medical Associates
• Daniel Souza, LVN
• Katie Erin Souza, P.T.A.
• Marvin Souza, RPH

• Medical Physician Assistant in Merced, CA
• Providers in Merced, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.

Verify at the official NPI Registry.