Healthcare Provider Details

I. General information

NPI: 1598843468
Provider Name (Legal Business Name): VICHAI PHUNGRASAMEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 S PATTERSON AVE SUITE # 140
SANTA BARBARA CA
93111-2400
US

IV. Provider business mailing address

334 S PATTERSON AVE SUITE # 140
SANTA BARBARA CA
93111-2400
US

V. Phone/Fax

Practice location:
  • Phone: 805-967-3432
  • Fax: 805-967-9893
Mailing address:
  • Phone: 805-967-3432
  • Fax: 805-967-9893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA32127
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: