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NPI Code Detail

MEDICARE: SAYSOMBOUN SOUVANNARATH

MEDICARE: SAYSOMBOUN SOUVANNARATH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramCA

General Provider Information

NPI Number : 1508723354
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAYSOMBOUN SOUVANNARATH
Provider Business Mailing Address
First Line : 3947 LENNANE DR STE 110
Second Line :
City : SACRAMENTO
State : CA
Zip : 95834-1971
Country : US
Telephone Number : 916-364-8395
Fax Number :
Provider Business Practice Location Address
First Line : 3947 LENNANE DR STE 110
Second Line :
City : SACRAMENTO
State : CA
Zip : 95834-1971
Country : US
Telephone Number : 916-364-8395
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2026
Last Update Date : 01/19/2026

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Directions to “ SAYSOMBOUN SOUVANNARATH ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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