Sourivanh, Phokham Mike
Sourivanh, Phokham Mike is an individual health care provider with primary practice located at Camp Pendleton , Apo AP 92055. He recently has only one registered license in Other Service Providers / Military Health Care Provider, which is considered as his primary health care specialty. Sourivanh, Phokham Mike can be contacted via phone (760) 725-1288.Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Military Health Care Provider | 171000000X |
Profile Details
| NPI number | 1972022762 |
|---|---|
| LBN Legal business name | Sourivanh, Phokham Mike |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 13th, 2017 |
| Last updated | Apr 21st, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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