Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Duangtavan Sourivong

Organization Methadone Clinic · NPI 1285821389

Duangtavan Sourivong is a Methadone Clinic in San Diego, California. Licensed in California. Registered with an NPI since 2007.

Licensed in
CA
In the registry since
2007

Practice location Address checks out

3940 Home Ave
San Diego, CA 92105-5952
Phone: (619) 262-8000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Methadone Clinic (primary) Taxonomy 261QM2800X (CA)

Record details

NPI number1285821389
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Bobby Stearns — Clinic Director · (619) 262-8000
NPI enumeratedOctober 2, 2007
Last updated in NPPESOctober 2, 2007
Mailing address4852 Jarrett Ct, San Diego, CA 92113-3598

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