Souliyo Phetsomphou

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

95223927 Issued in CA

Practice address

1165 Montgomery Dr
Santa Rosa, CA 95405-4801

Phone

(707) 525-5300

NPI assigned

Oct 5, 2026

Last updated

Oct 5, 2026By 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

Other names 1

• Yo Phetsomphou Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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

{
    "created_epoch": "1791158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791158400000",
    "number": "1548164692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1776 STILLWATER PL",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954038512",
            "telephone_number": "808-782-9224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1165 MONTGOMERY DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054801",
            "telephone_number": "707-525-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHETSOMPHOU",
        "first_name": "SOULIYO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2026-10-05",
        "last_updated": "2026-10-05",
        "certification_date": "2026-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95223927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "YO",
            "last_name": "PHETSOMPHOU",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Sheena Phan-Wu
• Jennifer Kim Phan
• Tuan Quoc Phan, LVN
• Valerie Phan
• Makha Phetphommasouk
• Philippe Edouard, M.D., Inc.
• Deirdre Phillips
• Dustin Phillips
• Elizabeth Phillips, MD
• Justin D. Phillips, DDS

• Registered Nurse in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.