Individual
DR. PANE AKSONE NOUVONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
200 MEDICAL PLAZA SUITE 526, LOS ANGELES, CA 90095-2007
(310) 267-0172
(310) 725-4037
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
E4265
CA
213ES0131X
Foot Surgery Podiatrist
Primary
E4265
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E4265
CA DPM LIC
CA
Enumeration date
09/15/2006
Last updated
01/05/2021
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