Individual provider Active NPI

Sabrina Ly Vangkhue

  • Physician Assistant
  • Sacramento, CA
National Provider Identifier
1760189336
Registry record updated Oct 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA63497 Issued in CA
Practice address
1495 River Park Dr Ste 200
Sacramento, CA 95815-4517
Phone
(916) 925-7020
Fax
(916) 925-3680
NPI assigned
Feb 14, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Athletic Trainer 2255A2300X
Physician Assistant 363A00000X PA63497 CA Primary

Addresses

Primary practice location

1495 River Park Dr Ste 200
Sacramento, CA 95815-4517

Mailing address

1495 River Park Dr Ste 200
Sacramento, CA 95815-4517
Phone (916) 925-7020

Medicare participation

Medicare enrollment files
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: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231229000009 CA Practitioner - Physician Assistant 7719337021 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA63497CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Kallos Surgery Center Inc. Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: svangkhue225334@hpmg.direct-ci.net

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1676332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759276800000",
    "number": "1760189336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1495 RIVER PARK DR STE 200",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958154517",
            "telephone_number": "916-925-7020",
            "fax_number": "916-925-3680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1495 RIVER PARK DR STE 200",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958154517",
            "telephone_number": "916-925-7020",
            "fax_number": "916-925-3680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANGKHUE",
        "first_name": "SABRINA",
        "middle_name": "LY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-14",
        "last_updated": "2025-10-01",
        "certification_date": "2025-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA63497",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.