Provider Demographics
NPI:1962220202
Name:SAEPHANH, DAWSON
Entity type:Individual
Prefix:
First Name:DAWSON
Middle Name:
Last Name:SAEPHANH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4879 E KINGS CANYON RD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-3811
Mailing Address - Country:US
Mailing Address - Phone:559-493-0625
Mailing Address - Fax:
Practice Address - Street 1:4871 E KINGS CANYON RD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-3811
Practice Address - Country:US
Practice Address - Phone:559-493-0625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker