MEDICARE: MR. WITOON S KRAILAS 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	207V00000X	Obstetrics & Gynecology Physician	A33395	CA

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

General Provider Information

NPI Number	:	1265432207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WITOON S KRAILAS MD

Provider Business Mailing Address
First Line	:	3839 W 1ST ST
Second Line	:	STE B8
City	:	SANTA ANA
State	:	CA
Zip	:	92703-4075
Country	:	US
Telephone Number	:	714-554-8966
Fax Number	:	714-554-8988

Provider Business Practice Location Address
First Line	:	3839 W 1ST ST
Second Line	:	STE B8
City	:	SANTA ANA
State	:	CA
Zip	:	92703-4075
Country	:	US
Telephone Number	:	714-554-8966
Fax Number	:	714-554-8988

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	07/08/2007

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