Kongsab La Hatlavongsa, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

61581 Issued in CA

Practice address

121 Barboza St
Mendota, CA 93640-1901

Phone

(559) 655-5000

NPI assigned

Jul 25, 2012

Last updated

Mar 25, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kongsab.hatlavongsa.1@17661.direct.athenahealth.com

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

• Fresno Community Hospital and Medical Center

  dba Community Regional Medical Center

  • General Acute Care Hospital
  • Fresno, CA
  • NPI 1104906569
  NPD (past)
• United Health Centers of the San Joaquin Valley

  • Federally Qualified Health Center (FQHC)
  • Huron, CA
  • NPI 1134101686
  NPD (past)

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

{
    "created_epoch": "1343174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395705600000",
    "number": "1366798530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3035 N MCARTHUR AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "93727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 BARBOZA ST",
            "city": "MENDOTA",
            "state": "CA",
            "postal_code": "936401901",
            "telephone_number": "559-655-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HATLAVONGSA",
        "first_name": "KONGSAB",
        "middle_name": "LA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-25",
        "last_updated": "2014-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "61581",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Firebaugh and Mendota Health Clinics, Inc. (Mendota Family Health Clinic)
• Fresno County Behavioral Health
• Keyly Cristal Fuentes Delcid, ACSW
• Veronica Antonina Gariuc, DDS
• Ravleen Kaur Gill
• Imgrx SJ Valley, Inc. (United Health Centers Pharmacy Mendota)
• Gayathri Parameswaran Iyer
• Mandeep Kaur, M.D.
• Bum Kim, DDS
• Marione Jill Tafalla Lear, FNP

• Dentist in Mendota, CA
• Providers in Mendota, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2014; 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.

Verify at the official NPI Registry.