Vongsa, Sourasack Kit
Vongsa, Sourasack Kit is an individual health care provider with primary practice located at 2500 E Capitol Dr Ste 1200 , Appleton WI 54911. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Vongsa, Sourasack Kit can be contacted via phone (920) 830-6877.Contact Information
Primary practice address
2500 E Capitol Dr Ste 1200
Appleton WI 54911
Phone: (920) 830-6877
Fax: (800) 236-2236
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 47253 | Wisconsin |
Profile Details
| NPI number | 1619945524 |
|---|---|
| LBN Legal business name | Vongsa, Sourasack Kit |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 8th, 2006 |
| Last updated | Aug 19th, 2019 - about 5 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 | 1619945524 | NPPES |
| Wisconsin | MEDICAID | 34808400 |
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