Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD60279701 | WA |
N | 207RA0201X | Internist - Allergy & Immunology | MD157966 | OR |
N | 207RA0201X | Internist - Allergy & Immunology | N7557 | TX |
NPI | 1538364450 |
---|---|
Provider Name | Dr. Evelyn Leechawengwongs |
First Address | Vancouver, WA 98683-0499 |
Second Address | Vancouver, WA 98683-0499 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2007 |
Last Update Date | 06/09/2012 |