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NPI Code Detail

MEDICARE: CORY BOUNPHAKDY

MEDICARE: CORY BOUNPHAKDY
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1851250625
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORY BOUNPHAKDY
Provider Business Mailing Address
First Line : 1117 MEADOWBROOK LN SW
Second Line :
City : CONCORD
State : NC
Zip : 28027-1739
Country : US
Telephone Number : 860-514-9326
Fax Number :
Provider Business Practice Location Address
First Line : 525 N TRYON ST STE 1600
Second Line :
City : CHARLOTTE
State : NC
Zip : 28202-0213
Country : US
Telephone Number : 855-832-6727
Fax Number : 772-675-9100
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2026
Last Update Date : 01/19/2026

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Directions to “ CORY BOUNPHAKDY ” Practice Location

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