DEPARTMENT OF INSURANCE

Affiliations

Name	Souriyavongsa, Saleumphon	DOIID	882504	NAIC NPN	17636019

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Health	7/7/2015	2/28/2027
Active	Non Resident	Agent	Personal Lines	4/14/2017	2/28/2027
Active	Non Resident	Agent	Life	7/7/2015	2/28/2027
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	12/15/2024	02/28/2025	02/07/2025	02/07/2025	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Accendo Insurance Company	300312	Agent - Health	9/10/2021	11/17/2023
Active	Accendo Insurance Company	300312	Agent - Life	6/26/2020
Active	Aetna Health Inc. (PA)	660717	Agent - Health	6/3/2020
Active	Aetna Health and Life Insurance Company	300523	Agent - Health	6/17/2020
Active	Aetna Health of Ohio Inc.	1065035	Agent - Health	7/28/2020
Active	Aetna Life Insurance Company	301140	Agent - Health	6/3/2020
Inactive	American Continental Insurance Company	643130	Agent - Life	6/17/2020	8/11/2021
Inactive	American General Life Insurance Company	301585	Agent - Health	7/13/2015	3/28/2018
Inactive	American General Life Insurance Company	301585	Agent - Life	7/13/2015	3/28/2018
Inactive	Anthem Health Plans of New Hampshire, Inc.	944064	Agent - Health	9/24/2021	8/30/2024
Active	Anthem Insurance Companies, Inc.	300941	Agent - Health	9/24/2021
Active	Anthem Life Insurance Company	301209	Agent - Health	5/13/2020
Active	Anthem Life Insurance Company	301209	Agent - Life	5/13/2020
Active	Care Improvement Plus South Central Insurance Company	799697	Agent - Health	7/20/2022
Active	Compcare Health Services Insurance Corporation	948751	Agent - Health	9/24/2021
Active	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Health	6/17/2020
Active	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Life	6/1/2023
Active	Devoted Health Insurance Company of Kentucky, Inc.	1306593	Agent - Health	8/16/2024
Inactive	Farmers Direct Property and Casualty Insurance Company	300957	Agent - Personal Lines	5/19/2017	9/24/2020
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Personal Lines	5/19/2017	9/24/2020
Inactive	LM General Insurance Company	300133	Agent - Personal Lines	8/28/2017	6/20/2024
Inactive	Liberty Insurance Corporation	300444	Agent - Personal Lines	8/28/2017	2/13/2025
Active	Progressive Casualty Insurance Company	300696	Agent - Personal Lines	5/22/2017
Active	SilverScript Insurance Company	663526	Agent - Health	6/3/2020
Inactive	Standard Fire Insurance Company (The)	301068	Agent - Personal Lines	12/20/2017	5/15/2020
Inactive	Travelers Commercial Insurance Company	301506	Agent - Personal Lines	2/7/2018	5/15/2020
Inactive	United States Life Insurance Company in the City of New York	301126	Agent - Health	7/13/2015	3/28/2018
Inactive	United States Life Insurance Company in the City of New York	301126	Agent - Life	7/13/2015	3/28/2018
Active	UnitedHealthcare Insurance Company	300946	Agent - Health	8/21/2020
Inactive	UnitedHealthcare Insurance Company of the River Valley	1027817	Agent - Health	8/21/2020	12/22/2022
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	8/21/2020	12/23/2021
Active	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	8/21/2020
Inactive	Unitrin Direct Property & Casualty Company	637443	Agent - Personal Lines	3/14/2018	10/2/2023
Active	WellCare Health Insurance Company of Kentucky, Inc.	301478	Agent - Health	5/1/2020
Inactive	WellCare Prescription Insurance Inc.	654329	Agent - Health	5/1/2020	12/29/2021

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date
Active	Designated Agent Company Inc.	681257	Agent - Health	5/13/2020
Active	Designated Agent Company Inc.	681257	Agent - Life	5/13/2020
Denied	Mercer Health & Benefits Administration LLC	656414	Agent - Health
Denied	Mercer Health & Benefits Administration LLC	656414	Agent - Life
Active	Mercer Health & Benefits Administration LLC	656414	Agent - Personal Lines	1/28/2019