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

Lyshawn Xatiy Phommakhoth

Individual provider Physician Assistant · NPI 1306627260

Lyshawn Xatiy Phommakhoth is a Physician Assistant in Sacramento, California. Practices as a sole proprietor. Licensed in California.

Licensed in
CA
In the registry since
2023

Practice location Address checks out

8120 Timberlake Way Ste 108
Sacramento, CA 95823-5413
Phone: (916) 252-5000
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 64438 (CA)

Record details

NPI number1306627260
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedOctober 6, 2023
Last updated in NPPESAugust 7, 2024
Certification dateAugust 7, 2024

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