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NPI Code Detail

MEDICARE: SUNISA CHANYAPUTHIPONG MD

MEDICARE: SUNISA CHANYAPUTHIPONG 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
1207Q00000XFamily Medicine PhysicianMD25513OR

General Provider Information

NPI Number : 1396791885
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUNISA CHANYAPUTHIPONG MD
Provider Business Mailing Address
First Line : 115 NE MAY LN
Second Line :
City : MCMINNVILLE
State : OR
Zip : 97128-9272
Country : US
Telephone Number : 503-472-1338
Fax Number : 503-434-8597
Provider Business Practice Location Address
First Line : 115 NE MAY LN
Second Line :
City : MCMINNVILLE
State : OR
Zip : 97128-9272
Country : US
Telephone Number : 503-472-1338
Fax Number : 503-434-8597
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2006
Last Update Date : 01/19/2012

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Directions to “ SUNISA CHANYAPUTHIPONG MD” Practice Location

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