Active NPI
Van Sieng Prom, D.C
- Chiropractor
- Modesto, CA
National Provider Identifier
1437467461
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(14) exclusion effective May 18, 2017.
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 21786
- Practice address
- 1031 McHenry Ave. Ste. 22
Modesto, CA 95350 - Phone
- (209) 527-7766
- Fax
- (209) 529-7766
- NPI assigned
- Sep 24, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 21786 | CA | Primary |
Addresses
Primary practice location
1031 McHenry Ave. Ste. 22
Modesto, CA 95350
Mailing address
1031 McHenry Ave Ste 22
Modesto, CA 95350-5434
Phone (209) 527-7766
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21786 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285286400000",
"number": "1437467461",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1031 MCHENRY AVE STE 22",
"city": "MODESTO",
"state": "CA",
"postal_code": "953505434",
"telephone_number": "209-527-7766",
"fax_number": "209-529-7766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1031 MCHENRY AVE. STE. 22",
"city": "MODESTO",
"state": "CA",
"postal_code": "95350",
"telephone_number": "209-527-7766",
"fax_number": "209-529-7766"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROM",
"first_name": "VAN",
"middle_name": "SIENG",
"name_prefix": "Dr.",
"credential": "D.C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-09-24",
"last_updated": "2010-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "21786",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
- Progressive Home Health and Hospice Care, LLC
- Progressive Home Health and Hospice Care, LLC
- Progressive Pharmacy, LLC
- Progressive Specialty Therapy Services LLC
- Progressive Urgent Care Inc
- Lindsey Provencher, PCCI
- Joseph Johnny Provenzano Jr., DO
- Proveri Ventures LLC
- Proveri Ventures LLC
- Providence Family Practice Medical Group
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.