Tommy Phoukhaothong Panyanouvong

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

MPSS-IUXREV Issued in CA

Practice address

1300 Payne Ave
Modesto, CA 95351-4821

Phone

(209) 541-0662

NPI assigned

Jan 9, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1326067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747785600000",
    "number": "1407126469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 SCENIC DR",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953506131",
            "telephone_number": "209-558-4464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 PAYNE AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953514821",
            "telephone_number": "209-541-0662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANYANOUVONG",
        "first_name": "TOMMY",
        "middle_name": "PHOUKHAOTHONG",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-01-09",
        "last_updated": "2025-05-21",
        "certification_date": "2025-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "372600000X",
            "taxonomy_group": "",
            "desc": "Adult Companion",
            "state": "CA",
            "license": "MPSSIUXREV",
            "primary": false
        },
        {
            "code": "372600000X",
            "taxonomy_group": "",
            "desc": "Adult Companion",
            "state": "CA",
            "license": "MPSS-IUXREV",
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "CA",
            "license": "MPSS-IUXREV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jazmine Pantoja
• Leslie Pantoja
• Lizbeth Pantoja
• Jason Panugaling, PT, DPT
• Kevin Panyanouvong, LCSW
• William Papanickolas, MD
• Trinity Parada
• Paradaise Medical Office
• Roxanne T Paradeza
• Amy Mailand Paradis, NNP, CNS

• Peer Specialist in Modesto, CA
• Providers in Modesto, CA by specialty
• Peer Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2025; 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.