Individual provider Active NPI

Valerie Isaree Pooudomsak, MD

  • Psychiatry Physician
  • Orange, CA
National Provider Identifier
1861017873
Registry record updated May 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A179010 Issued in CA
Practice address
101 The City Dr S
Orange, CA 92868-3201
Phone
(714) 456-7890
NPI assigned
Jun 15, 2020
Last updated
May 25, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 25, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X A179010 CA Primary

Addresses

Primary practice location

101 The City Dr S
Orange, CA 92868-3201

Mailing address

101 The City Dr S
Orange, CA 92868-3201
Phone (714) 456-7890

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210608002585 CA Order and Referring Only - PsychiatryPractitioner - Psychiatry 0244630564

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A179010CAMDPsychiatry Physician

NPI Registry JSON

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

{
    "created_epoch": "1592179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684972800000",
    "number": "1861017873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 THE CITY DR S",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683201",
            "telephone_number": "714-456-7890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 THE CITY DR S",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683201",
            "telephone_number": "714-456-7890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POOUDOMSAK",
        "first_name": "VALERIE",
        "middle_name": "ISAREE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-15",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A179010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.