MR. BOUNCHANH TRYSAVATH (NPI# 1013139054) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013139054 |
| Entity Type | Individual |
| Full Name | MR. BOUNCHANH TRYSAVATH |
| Practice Address |
300 I St Modesto CA 95351 |
| Mailing Address |
300 I Street Modesto CA 95351 |
| Practice Telephone | 2095212632 |
| Practice Fax Number | 2095212651 |
| Mailing Telephone | 2095212632 |
| Mailing Fax Number | 2095221794 |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 12712 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
300 I ST |
| City | MODESTO |
| State | CA |
| Zip Code | 95351 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235335431 | Samakhom Medical Clinic Inc | Clinic/Center | 300 I St, Modesto, CA 95351-2826 | 2007-06-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700392487 | Western Dental Services, Inc. | Dentist | 1524 Richland Ave, Ceres, CA 95351 | 2017-12-18 |
| 1881039873 | Sabrina Arora-thissen | Family Medicine | 401 Paradise Rd. Ste, Modesto, CA 95351 | 2013-05-03 |
| 1407163561 | Maliza Cahee Oliver | Dentist | 1404 Mitchell Rd, Modesto, CA 95351 | 2010-09-09 |
| 1124345616 | Jason Lee Paul Wayrynen | Social Worker | 1219 N Carpenter Rd Ste 12, Modesto, CA 95351 | 2010-04-23 |
| 1841469640 | Edgar Hse-hwa Han | Physical Medicine & Rehabilitation | 1521 N. Carpenter Road, Suite D-1, Modesto, CA 95351 | 2008-02-26 |
| 1326259326 | Karen Ann Peterson | Nurse Practitioner | 1340 Mitchell Rd, Modesto, CA 95351 | 2007-05-24 |
| 1245363464 | Sharon Basaldua1 | Counselor | 813 Moon Lane, Modesto, CA 95351 | 2007-03-14 |
| 1710046834 | Phil Chen | Dentist | 1460 Mitchell Road, Suite B, Modesto, CA 95351 | 2006-12-06 |
| 1649366055 | Victor Y. Chen | Family Medicine | 401 Paradise Road, Suite E, Modesto, CA 95351 | 2006-10-04 |
| 1487679296 | Ronald M Megee | Chiropractor | 2507 East Hatch Rd., Suite B, Modesto, CA 95351 | 2006-07-13 |
| Find all providers in zip 95351 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609330109 | Daniel Antonio Villagran-gonzalez | Physician Assistant | 1401 Spanos Ct Ste 130, Modesto, CA 95355-2815 | 2019-01-29 |
| 1255823191 | Laura Lee Ruby Goen | Physician Assistant | 3105 Mchenry Ave Ste 10, Modesto, CA 95350-1439 | 2018-06-06 |
| 1679086755 | Danielle B Deen | Physician Assistant | 1541 Florida Ave Ste 100, Modesto, CA 95350-4438 | 2017-11-10 |
| 1598292724 | Todd Brooks | Physician Assistant | 1800 Coffee Rd Ste 30, Modesto, CA 95355-2700 | 2017-05-18 |
| 1205240660 | David Zarate Rojas | Physician Assistant | 405 Mid Pines Way, Modesto, CA 95354-3378 | 2014-06-13 |
| 1194151704 | Harinder Jhatu | Physician Assistant | 2218 W Whitmore Ave, Modesto, CA 95358-9497 | 2013-09-16 |
| 1902191489 | Heather Marie Clayton-young | Physician Assistant | 3509 Coffee Rd Ste D3, Modesto, CA 95355-1357 | 2011-06-13 |
| 1457553885 | Michael Tannenbaum | Physician Assistant | 1808 Scenic Dr, Apt 107, Modesto, CA 95355 | 2007-06-05 |
| 1942378583 | Karen Fields | Physician Assistant | Valley Wound Healing Center, 4335a Nstarway, Modesto, CA 95356 | 2006-12-01 |
| 1760594154 | Stephen Andrew Fall | Physician Assistant | 1335 Coffee Rd Ste 100, Modesto, CA 95355-3192 | 2006-08-31 |
| Find all providers in MODESTO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.