Individual
BOUNYAVETH PHACHOMPHON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
320 BROADMOOR DR, SOUTH SIOUX CITY, NE 68776-3806
(402) 508-0009
Mailing address
320 BROADMOOR DR, SOUTH SIOUX CITY, NE 68776-3806
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
—
Other
Enumeration date
11/17/2025
Last updated
11/17/2025
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