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General NPI Number Information
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NPI Number | 1902061815
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Entity Type | Organization
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Legal Business Name | KETSANA VILAYSANE MD, INC.
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Dates
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Enumeration Date | 07/21/2008
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Last Update Date | 07/21/2008
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Provider Practice Location Address
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Address Line | 6183 N FRESNO ST STE 101
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City | FRESNO
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State | CA
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Zip | 93710-8611
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Country | US
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Telephone | 559-432-5003
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Fax | 559-432-5008
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Provider Business Mailing Address
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Address Line | 6183 N FRESNO ST STE 101
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City | FRESNO
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State | CA
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Zip | 93710-8611
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Country | US
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Telephone | 559-432-5003
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Fax | 559-432-5008
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KETSANA VILAYSANE
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Credential | M.D
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Telephone | 559-432-5003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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