Healthcare Provider Details

I. General information

NPI: 1124945456
Provider Name (Legal Business Name): CMK CENTER FOR EARLY INTERVENTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 BELMONT ST APT 303
OAKLAND CA
94610-4823
US

IV. Provider business mailing address

1100 MELODY LN STE 2026
ROSEVILLE CA
95678-5167
US

V. Phone/Fax

Practice location:
  • Phone: 407-907-5069
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SIRIKANYA CHIRAROEKMONGKON
Title or Position: OWNER
Credential: MD
Phone: 407-907-5069