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General NPI Number Information
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NPI Number | 1124945456
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Entity Type | Organization
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Legal Business Name | CMK CENTER FOR EARLY INTERVENTION
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Dates
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Enumeration Date | 06/29/2026
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Last Update Date | 06/29/2026
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Provider Practice Location Address
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Address Line | 381 BELMONT ST APT 303
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City | OAKLAND
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State | CA
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Zip | 94610-4823
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Country | US
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Telephone | 407-907-5069
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 MELODY LN STE 2026
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City | ROSEVILLE
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State | CA
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Zip | 95678-5167
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SIRIKANYA CHIRAROEKMONGKON
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Credential | MD
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Telephone | 407-907-5069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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