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1104826916

NPI Code Detail

MEDICARE: DR. TONY SANGCHOMPUPHEN MD

MEDICARE: DR. TONY SANGCHOMPUPHEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	35081743	OH
2	2085R0202X	Diagnostic Radiology Physician	2006002250	MO
3	2085R0202X	Diagnostic Radiology Physician	47326	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	019469	OTHER	CO	KAISER COMMERCIAL NUMBER
5	300136030	OTHER	OH	SOR RR MDCR PIN NUMBER
6	P00202433	OTHER	OH	SOM RR MDCR PIN NUMBER

General Provider Information

NPI Number	:	1104826916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TONY SANGCHOMPUPHEN MD

Provider Business Mailing Address
First Line	:	10350 E DAKOTA AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80247-1314
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2045 N FRANKLIN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-5437
Country	:	US
Telephone Number	:	303-338-4545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	04/20/2021

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Directions to “ DR. TONY SANGCHOMPUPHEN MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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