Active NPI
Nokeo Songvilay, D.O.
- Family Medicine Physician
- San Diego, CA
National Provider Identifier
1922015056
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 20A6639
- Practice address
- 1807 Robinson Ave
Suite 107
San Diego, CA 92103-7633 - Phone
- (619) 692-9331
- Fax
- (619) 692-9403
- NPI assigned
- Aug 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 20A6639 | CA | Primary |
Addresses
Primary practice location
1807 Robinson Ave
Suite 107
San Diego, CA 92103-7633
Mailing address
1807 Robinson Ave
Suite 107
San Diego, CA 92103-7633
Phone (619) 692-9331
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00AX66390 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20A6639 | CA | MD | Family Medicine Physician |
| 6639 | CA | MD | Speech-Language Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1520553600000",
"number": "1922015056",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1807 ROBINSON AVE",
"address_2": "SUITE 107",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921037633",
"telephone_number": "619-692-9331",
"fax_number": "619-692-9403"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1807 ROBINSON AVE",
"address_2": "SUITE 107",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921037633",
"telephone_number": "619-692-9331",
"fax_number": "619-692-9403"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SONGVILAY",
"first_name": "NOKEO",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-02",
"last_updated": "2018-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "20A6639",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00AX66390",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2018; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.