Provider Demographics
NPI:1992936157
Name:SOPHAMIXAY-ESSEGIAN, SY (DO)
Entity type:Individual
Prefix:DR
First Name:SY
Middle Name:
Last Name:SOPHAMIXAY-ESSEGIAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4969 E FLORADORA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1924
Mailing Address - Country:US
Mailing Address - Phone:559-892-8795
Mailing Address - Fax:
Practice Address - Street 1:121 SIERRA ST
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631-1732
Practice Address - Country:US
Practice Address - Phone:559-326-5320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10120207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine