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General NPI Number Information
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NPI Number | 1275630196
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Entity Type | Individual
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Provider Name | KRAIVIT ANGSUPANICH M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 09/17/2008
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Provider Practice Location Address
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Address Line | 801 11TH ST SUITE 1
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City | LAKEPORT
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State | CA
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Zip | 95453-4100
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Country | US
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Telephone | 707-262-5568
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Fax | 707-263-6888
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Provider Business Mailing Address
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Address Line | 801 11TH ST SUITE 1
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City | LAKEPORT
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State | CA
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Zip | 95453-4100
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Country | US
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Telephone | 707-262-5568
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Fax | 707-263-6888
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A34208
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License Number State | CA
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