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General NPI Number Information
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NPI Number | 1841211497
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Entity Type | Individual
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Provider Name | VICHAI BHOOPAT M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 12/19/2012
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Provider Practice Location Address
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Address Line | 3801 KATELLA AVE STE 301
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3373
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Country | US
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Telephone | 562-493-4466
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Fax | 562-493-4466
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Provider Business Mailing Address
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Address Line | 13492 GRINNELL CIR
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City | WESTMINSTER
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State | CA
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Zip | 92683-1734
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Country | US
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Telephone | 714-897-2735
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Fax | 714-897-2735
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A25146
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License Number State | CA
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