DEPARTMENT OF INSURANCE

Name	Khouanlak, Phetsakhone Kang	DOIID	987723	NAIC NPN	18704143

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date	Designated Home State
Inactive	Non Resident	Independent Adjuster	Property & Casualty	6/26/2020	6/29/2020
Active	Non Resident	Staff Adjuster	Property & Casualty	6/29/2020		6/30/2026	Texas

*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
Staff Adjuster	04/15/2024	06/30/2024	05/31/2024	05/31/2024	Yes

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date. Licensees subject to CE must complete CE requirements before Next Compliance Date in order to successfully complete the License Renewal Process.

Address Information

Type	Address
Business / Home Office	4211 W Boy Scout Blvd Ste 800 Tampa, FL 336075757
Residence	Not Public Information

Phone Information

Type	Phone
Business / Home Office	(608) 825-5420