Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0700X | Prosthodontist | 45002 | CA |
Y | 1223X0400X | Orthodontists | 45002 | CA |
NPI | 1245350826 |
---|---|
Provider Name | Dr. Kitichai Rungcharassaeng |
First Address | Redlands, CA 92373-7434 |
Second Address | Loma Linda, CA 92350-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 15/01/2021 |