PUKAN PHAOUDOM
NPI 1790844512
Social Worker - Clinical in Fresno, CA

Q: What is Pukan Phaoudom's NPI number?

The NPI number for Pukan Phaoudom is 1790844512. It was assigned to this individual provider in the NPPES registry on December 7, 2006.

Q: What is Pukan Phaoudom's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Q: When was this NPI record last updated?

The NPPES record for Pukan Phaoudom was last updated on May 20, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.

Active since December 07, 2006PECOS Enrolled

1925 E DAKOTA AVE, FRESNO, CA 93726(559) 600-5982 Get Directions Write a Review

NPPES record last updated: May 20, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: May 20, 2026, Sep 17, 2024, May 28, 2019 and 1 more (4 updates tracked since 2019).

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About Pukan Phaoudom NPPES

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

PUKAN PHAOUDOM (NPI 1790844512) is an individual clinical provider in Fresno, California, licensed in California (LCSW25857) and active in the NPI registry since December 2006. He is enrolled in Medicare PECOS and maintains a secondary practice location in Fresno.

NPPES Registry Identity

NPI1790844512

Entity TypeIndividualMale

Primary Taxonomy1041C0700X

Provider Legal NamePUKAN PHAOUDOM

Location Address1925 E DAKOTA AVEFresno, CA 93726-4821

Mailing Address1925 E Dakota AveFresno, CA 93726-4821 · (559) 600-5982

Phone(559) 600-5982

Sole ProprietorNo

Enumeration DateDecember 7, 2006

Last NPPES UpdateMay 20, 20264 updates tracked since enumeration

NPPES CertifiedMay 20, 2026

✔ NPI 1790844512 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code1041C0700X

License✔ Licensed in CA · LCSW25857

Definition

A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

1925 E DAKOTA AVE, Fresno, CA 93726

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Secondary Practice Location 1

Location 12171 N Fine AveFresno, CA 93727-1519 · Phone (559) 455-2040 ext. 2143

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Pukan Phaoudom is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Pukan Phaoudom reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

County Of Fresno

Same address

Mental Health (Including Community Mental Health Center)

1925 E DAKOTA AVE
Fresno, CA 93726

Reassigned Medicare billing, California enrollment
99 clinicians in this Medicare group

NPI 1770538001 (559) 600-9058

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 93726 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$0.00 typical visit price

range $58.87 – $176.60

Typical copayment $0.00 (range $14.71 – $44.15)

Most-billed visit code NA

Established Patient

$73.16 typical visit price

range $19.28 – $144.60

Typical copayment $18.29 (range $4.82 – $36.15)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JASON STUTZMAN

Clinic/Center (Infusion Therapy)