Wongkittiroch, Khongruk
Wongkittiroch, Khongruk is an individual health care provider with primary practice located at 2838 E Oakland Park Blvd Ste 201, Fort Lauderdale FL 33306-1814. She recently has 6 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / Clinical & Laboratory Dermatological Immunology, Allopathic & Osteopathic Physicians / Dermatopathology, Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery, Allopathic & Osteopathic Physicians / Pediatric Dermatology, Allopathic & Osteopathic Physicians / Procedural Dermatology. Allopathic & Osteopathic Physicians / Dermatology is her primary health care specialty. Wongkittiroch, Khongruk can be contacted via phone (954) 564-0040.Contact Information
Primary practice address
2838 E Oakland Park Blvd Ste 201
Fort Lauderdale FL 33306-1814
Phone: (954) 564-0040
Fax: (954) 564-0048
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | OS11792 | Florida |
| Allopathic & Osteopathic Physicians / Clinical & Laboratory Dermatological Immunology | 207NI0002X | OS11792 | Florida |
| Allopathic & Osteopathic Physicians / Dermatopathology | 207ND0900X | OS11792 | Florida |
| Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery | 207ND0101X | OS11792 | Florida |
| Allopathic & Osteopathic Physicians / Pediatric Dermatology | 207NP0225X | OS11792 | Florida |
| Allopathic & Osteopathic Physicians / Procedural Dermatology | 207NS0135X | OS11792 | Florida |
Profile Details
| NPI number | 1205003068 |
|---|---|
| LBN Legal business name | Wongkittiroch, Khongruk |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 12th, 2008 |
| Last updated | Dec 18th, 2014 - about 12 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 | 1205003068 | NPPES |
| Florida | Other | 28528 | BLUE CROSS BLUE SHIELD OF FLORIDA |
| Florida | Other | 261637814 | BLUE CROSS BLUE SHIELD OF FLORIDA |
| Florida | Other | 317129 | BLUE CROSS BLUE SHIELD OF FLORIDA |
| Florida | Other | 261637814 | BLUE CROSS BLUE SHIELD OF FLORIDA |
| Florida | Other | 6375863 | BLUE CROSS BLUE SHIELD OF FLORIDA |
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