=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033225271
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHERAPHAT LOPANSRI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2006
-----------------------------------------------------
Last Update Date | 09/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 223 N GARFIELD AVE., #306
-----------------------------------------------------
City | MONTEREY PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-573-5005
-----------------------------------------------------
Fax | 626-573-8650
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 223 N GARFIELD AVE STE 306
-----------------------------------------------------
City | MONTEREY PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91754-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-573-5005
-----------------------------------------------------
Fax | 626-573-5601
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | A33669
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------