Active NPI
Neboneet Koochou
- Pharmacist
- Modesto, CA
National Provider Identifier
1861366981
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 91315
- Practice address
- 3712 Dillingham Ave
Modesto, CA 95357-1420 - Phone
- (209) 345-8911
- NPI assigned
- Oct 1, 2025
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 91315 | CA | Primary |
Addresses
Primary practice location
3712 Dillingham Ave
Modesto, CA 95357-1420
Mailing address
3712 Dillingham Ave
Modesto, CA 95357-1420
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 91315 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1759276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1759276800000",
"number": "1861366981",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3712 DILLINGHAM AVE",
"city": "MODESTO",
"state": "CA",
"postal_code": "953571420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3712 DILLINGHAM AVE",
"city": "MODESTO",
"state": "CA",
"postal_code": "953571420",
"telephone_number": "209-345-8911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOOCHOU",
"first_name": "NEBONEET",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-10-01",
"last_updated": "2025-10-01",
"certification_date": "2025-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "91315",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.