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TOMMY PHOUKHAOTHONG PANYANOUVONG
NPI 1407126469
Peer Specialist in Modesto, CA

Active since January 09, 2012
1300 PAYNE AVE, MODESTO, CA 95351(209) 541-0662 Get Directions Write a Review

NPPES record last updated: May 21, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Tommy Phoukhaothong Panyanouvong NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TOMMY PHOUKHAOTHONG PANYANOUVONG (NPI 1407126469) is an individual peer specialist in Modesto, California, licensed in California (MPSS-IUXREV) and active in the NPI registry since January 2012.

NPPES Registry Identity

NPI1407126469
Entity TypeIndividualMale
Primary Taxonomy175T00000X
Provider Legal NameTOMMY PHOUKHAOTHONG PANYANOUVONG
Location Address1300 PAYNE AVEModesto, CA 95351-4821
Mailing Address800 Scenic DrModesto, CA 95350-6131 · (209) 558-4464
Phone(209) 541-0662
Sole ProprietorNo
Enumeration DateJanuary 9, 2012
Last NPPES UpdateMay 21, 2025
NPPES CertifiedMay 21, 2025
✔ NPI 1407126469 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPeer SpecialistOther Service Providers
Taxonomy Code175T00000X
License✔ Licensed in CA · MPSS-IUXREV
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
Also ListedAdult CompanionTaxonomy 372600000X · License MPSSIUXREV (CA), MPSS-IUXREV (CA)
1300 PAYNE AVE, Modesto, CA 95351
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tommy Panyanouvong's NPI number?

The NPI number for Tommy Panyanouvong is 1407126469. It was assigned to this individual provider in the NPPES registry on January 9, 2012.

Where is Tommy Panyanouvong located?

Tommy Panyanouvong practices at 1300 Payne Ave, Modesto, CA 95351. The listed phone number is (209) 541-0662.

What is Tommy Panyanouvong's specialty?

The primary specialty registered for this NPI is Peer Specialist with taxonomy code 175T00000X.

When was this NPI record last updated?

The NPPES record for Tommy Panyanouvong was last updated on May 21, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.