Healthcare Provider Details

I. General information

NPI: 1437590312
Provider Name (Legal Business Name): HANSA WONGPRASERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 W CHILDS AVE
MERCED CA
95341-6862
US

IV. Provider business mailing address

1910 CUSTOMER CARE WAY
ATWATER CA
95301-5167
US

V. Phone/Fax

Practice location:
  • Phone: 866-682-4842
  • Fax: 877-436-1488
Mailing address:
  • Phone: 866-682-4842
  • Fax: 855-202-9336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA141533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: