Provider Demographics
NPI:1114704905
Name:SAYVONGSA, NIKA (BSN-RN)
Entity type:Individual
Prefix:
First Name:NIKA
Middle Name:
Last Name:SAYVONGSA
Suffix:
Gender:F
Credentials:BSN-RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MARIPOSA ST UNIT 119
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-3926
Mailing Address - Country:US
Mailing Address - Phone:479-857-6594
Mailing Address - Fax:
Practice Address - Street 1:2300 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2753
Practice Address - Country:US
Practice Address - Phone:415-600-3503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR221391163W00000X
CA95303661163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse