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NPI Code Detail

MEDICARE: SIRI HONGSATHAVIJ M.D.

MEDICARE: SIRI HONGSATHAVIJ M.D.
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
1208D00000XGeneral Practice PhysicianA37240CA

General Provider Information

NPI Number : 1205014339
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIRI HONGSATHAVIJ M.D.
Provider Business Mailing Address
First Line : 3712 WHITTIER BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90023-1733
Country : US
Telephone Number : 626-372-9549
Fax Number :
Provider Business Practice Location Address
First Line : 3712 WHITTIER BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90023-1733
Country : US
Telephone Number : 626-372-9549
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2008
Last Update Date : 01/31/2008

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