Itsara, Kriengsak

Itsara, Kriengsak is an individual health care provider with primary practice located at 305 E Granger Ave Ste 202, Modesto CA 95350-4344. He recently has only one registered license in Allopathic & Osteopathic Physicians / Nephrology, which is considered as his primary health care specialty. Itsara, Kriengsak can be contacted via phone (206) 526-1606.

Contact Information

Primary practice address
305 E Granger Ave Ste 202 Modesto CA 95350-4344
Phone: (206) 526-1606
Fax: (209) 526-1677
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X A33103 California

Profile Details

NPI number 1558363739
LBN Legal business name Itsara, Kriengsak
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 1st, 2005
Last updated Feb 25th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1558363739 NPPES
California MEDICAID 00A331030

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