Pukan Phaoudom

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW25857 Issued in CA

Practice address

1925 E Dakota Ave
Fresno, CA 93726-4821

Phone

(559) 600-5982

NPI assigned

Dec 7, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• County of Fresno

  dba Fresno County Department of Behavioral Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fresno, CA
  • NPI 1770538001
  Medicare reassignment
• Fresno County

  dba Metro Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fresno, CA
  • NPI 1023270907
  NPD
• Fresno County

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fresno, CA
  • NPI 1861527517
  NPD

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

{
    "created_epoch": "1165449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779235200000",
    "number": "1790844512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 E DAKOTA AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937264821",
            "telephone_number": "559-600-5982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 E DAKOTA AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937264821",
            "telephone_number": "559-600-5982"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2171 N Fine Ave",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937271519",
            "country_code": "US",
            "telephone_number": "559-455-2040 x2143",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAOUDOM",
        "first_name": "PUKAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-07",
        "last_updated": "2026-05-20",
        "certification_date": "2026-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW25857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vicki Phangrath, RN
• Vongphachanh Phanhdara
• Jim Pedram Phanucharas, M.D.
• Regina Sih Phanucharas, PHARM.D.
• Villa Phanvong
• Tyler W Pharis, OTR/L
• Pharmacy Corporation of America (Pharmerica)
• Pharmkee, Inc. (Community Medical Arts Pharmacy)
• Phase Care, Inc
• Joanna Toukta Phavongxai

• Clinical Social Worker in Fresno, CA
• Providers in Fresno, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2026; 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.