MEDICARE: DR. ARISARA SUWANGOMOLKUL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	247533-1	NY
2	207RN0300X	Nephrology Physician	A112389	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558595496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARISARA SUWANGOMOLKUL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 6789
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95927-6789
Country	:	US
Telephone Number	:	530-892-2300
Fax Number	:	530-894-5890

Provider Business Practice Location Address
First Line	:	285 COHASSET RD
Second Line	:	STE 100
City	:	CHICO
State	:	CA
Zip	:	95926-5513
Country	:	US
Telephone Number	:	530-892-2300
Fax Number	:	530-894-5890

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2009
Last Update Date	:	12/20/2021

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