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

Primary practice address

Camp Pendleton Apo AP 92055

Phone: (760) 725-1288

Fax:

Website:

Map and Directions

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 4 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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