Healthcare Provider Details

I. General information

NPI: 1639776644
Provider Name (Legal Business Name): PANYA MEUNSANITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 02/18/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1ST DNBN ATTN: CREDENTIALS
CAMP PENDLETON CA
92055-5221
US

IV. Provider business mailing address

NHCP 200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 951-434-9364
  • Fax:
Mailing address:
  • Phone: 951-434-9364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH29492
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: