Healthcare Provider Details

I. General information

NPI: 1720438708
Provider Name (Legal Business Name): WICHURAT SAKULPAPTONG DDS, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 X ST
SACRAMENTO CA
95818-2502
US

IV. Provider business mailing address

888 FOSTER CITY BLVD
FOSTER CITY CA
94404
US

V. Phone/Fax

Practice location:
  • Phone: 916-686-8914
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDENT.DE.70098530
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberSP338
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number41291
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: