Healthcare Provider Details

I. General information

NPI: 1952928707
Provider Name (Legal Business Name): KORNKANOK SARINGKARISATE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2020
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N BROADWAY
BALTIMORE MD
21205-1832
US

IV. Provider business mailing address

716 N BROADWAY FL 4
BALTIMORE MD
21205-1806
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-9520
  • Fax:
Mailing address:
  • Phone: 443-923-9520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMDR-7958
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: