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

Pukan Phaoudom

Individual provider Clinical Social Worker · NPI 1790844512

Pukan Phaoudom is a Clinical Social Worker in Fresno, California. Works from 2 locations. Licensed in California.

Licensed in
CA
In the registry since
2006
Specialties on file
2

Practice location Address checks out

1925 E Dakota Ave
Fresno, CA 93726-4821
Phone: (559) 600-5982
Show map & directions

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

Additional practice locations (1)

  • 2171 N Fine Ave, Fresno, CA 93727-1519 — (559) 455-2040

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence LCSW25857 (CA)
Clinical Social Worker Taxonomy 1041C0700X

Record details

NPI number1790844512
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedDecember 7, 2006
Last updated in NPPESMay 20, 2026
Certification dateMay 20, 2026

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