Kongsakul, Andy Keith
Kongsakul, Andy Keith is an sole proprietor health care provider with primary practice located at 19636 Sherman Way , Reseda CA 91335-3647. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Kongsakul, Andy Keith can be contacted via phone (818) 774-2020.Contact Information
Primary practice address
19636 Sherman Way
Reseda CA 91335-3647
Phone: (818) 774-2020
Fax: (818) 774-2021
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 13639T | California |
| Eye and Vision Services Providers / Optometrist | 152W00000X | TUV007213-1 | New York |
Profile Details
| NPI number | 1497949267 |
|---|---|
| LBN Legal business name | Kongsakul, Andy Keith |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 4th, 2007 |
| Last updated | Jan 5th, 2022 - about 2 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1497949267 | NPPES |
| California | MEDICAID | 1649400920 |
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