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Bounlath Kent Souksavong, PA
Medical Physician Assistant in Merced, California
NPI 1326021171

Bounlath Kent Souksavong is a Medical Physician Assistant based in Merced, CA and is specialized in Medical. Bounlath Kent Souksavong practices in Merced, CA and has the professional credentials of PA. The NPI Number for Bounlath Kent Souksavong is 1326021171 and holds a License No. PA12844 (California).

The current practice location address for Bounlath Kent Souksavong is 847 W Childs Ave, Merced, CA and can be reached out via phone at 209-383-7441 and via fax at 209-383-1643.

Location: 847 W Childs Ave, Merced, CA, 95340-6805
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Provider Profile Details
NPI Number
1326021171
Provider Name
Bounlath Kent Souksavong
Credential
PA
Provider Entity Type
Individual
Gender
Male
Address
847 W Childs Ave, Merced, CA, 95340-6805
Phone Number
209-383-7441
Fax Number
209-383-1643
Provider Enumeration Date
11/25/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1022633 01 CA NCCPA CERT #
institution
Provider Business Practice Location Address Details
Address
847 W Childs Ave
City
State
Zip
95341-6862
Phone Number
209-383-7441
Fax Number
209-383-1643
person
Provider Business Mailing Address Details
Address
847 W Childs Ave
City
State
Zip
95341-6862
Phone Number
209-383-7441
Fax Number
209-383-1643
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
PA12844 (California)
Definition
Definition to come...
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