Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Voottisin Michael Pisarnwongs, PA-C

Individual provider Physician Assistant · NPI 1124739354

Voottisin Michael Pisarnwongs, PA-C is a Physician Assistant in Pasadena, California. Qualified in 2022, 4 years ago. Practices with Shine Mmg Inc, a 25-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in California.

Years since qualifying
4
Licensed in
CA
In the registry since
2022
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

10 Congress St Ste 210
Pasadena, CA 91105-3027
Phone: (626) 995-4447
Fax: (424) 314-0550
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 8255 Vineyard Ave Apt 1200g, Rancho Cucamonga, CA 91730-7183 — (818) 400-1417

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA62297 (CA)

Record details

NPI number1124739354
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedDecember 8, 2022
Last updated in NPPESJune 29, 2023
Certification dateJune 29, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Shine Mmg Inc — 25 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

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