Provider Demographics
NPI:1972090652
Name:LUANGSRINHOTHA, SOUK
Entity type:Individual
Prefix:
First Name:SOUK
Middle Name:
Last Name:LUANGSRINHOTHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5021 ROSSO CT
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CA
Mailing Address - Zip Code:95368-9066
Mailing Address - Country:US
Mailing Address - Phone:209-855-6900
Mailing Address - Fax:
Practice Address - Street 1:5021 ROSSO CT
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CA
Practice Address - Zip Code:95368-9066
Practice Address - Country:US
Practice Address - Phone:209-855-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography