Pukan Phaoudom is a Clinical in Fresno, California. Pukan Phaoudom practices all healthcare services and medical treatments related to Clinical. The NPI Number for Pukan Phaoudom is 1790844512. The last update date is 2019-05-28.
Pukan Phaoudom's current location address is 4441 E Kings Canyon Rd, Fresno, California. You can contact this provider via phone number 5596004693. The mailing address for Pukan Phaoudom is 4441 E Kings Canyon Rd, Fresno, California. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Pukan Phaoudom |
|---|---|
| Address | 4441 E Kings Canyon Rd, Fresno, California |
| Phone Number | 5596004693 |
| Fax Number | |
| Sole Proprietor | N |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1790844512 |
|---|---|
| Provider Enumeration Date | 2006-12-07 |
| Last Updated Date | 2019-05-28 |
Provider Mailing Address Detail
| Address | 4441 E Kings Canyon Rd |
|---|---|
| City | Fresno |
| State | California (CA) |
| Post Code | 937023604 |
| Phone Number | 5596004693 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Clinical |
|---|---|
| Taxonomy | 1041C0700X |
| Licence No | LCSW25857 |
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Definition: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certif |
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What is the unique identification code assigned to Pukan Phaoudom by the Centers for Medicare & Medicaid Services?
The Pukan Phaoudom has been issued the NPI (National Provider Identifier) 1790844512. This 10-digit code serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Can you provide the Pukan Phaoudom's physical address?
The Pukan Phaoudom is physically located at 4441 E Kings Canyon Rd, in the city of Fresno, CA, with the postal code 937023604.
What is Pukan Phaoudom's specialized field of practice, and what is the corresponding taxonomy code that categorizes this area of expertise?
The area of specialization for Pukan Phaoudom is Clinical, and the taxonomy code that classifies this field of practice is 1041C0700X.
On what date did the Centers for Medicare & Medicaid Services issue the 1790844512 to Pukan Phaoudom?
The Pukan Phaoudom received its 1790844512 assignment from the Centers for Medicare & Medicaid Services on 2006-12-07.
When was the Pukan Phaoudom's information last updated?
The Pukan Phaoudom's information was last updated on 2019-05-28.
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