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:
Health care specialties
| Specialty | Code | License # | 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 18 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 | 1558363739 | NPPES |
| California | MEDICAID | 00A331030 |
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