Healthcare Provider Details

I. General information

NPI: 1093558801
Provider Name (Legal Business Name): THOMAS CHAIMONGKOL RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6947 FARMINGTON WAY
SACRAMENTO CA
95828-2214
US

IV. Provider business mailing address

6947 FARMINGTON WAY
SACRAMENTO CA
95828-2214
US

V. Phone/Fax

Practice location:
  • Phone: 916-716-5453
  • Fax:
Mailing address:
  • Phone: 916-716-5453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number47719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: