Provider Demographics
NPI:1093967747
Name:SAHATRUNGSINEE, PENSIRI
Entity Type:Individual
Prefix:
First Name:PENSIRI
Middle Name:
Last Name:SAHATRUNGSINEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:
Other - Last Name:SAHATRUNGSINEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:100 W CALIFORNIA BLVD
Mailing Address - Street 2:UNIT 25
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3010
Mailing Address - Country:US
Mailing Address - Phone:310-795-4577
Mailing Address - Fax:
Practice Address - Street 1:100 W CALIFORNIA BLVD
Practice Address - Street 2:UNIT 25
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3010
Practice Address - Country:US
Practice Address - Phone:310-795-4577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant