Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 36323 | TX |
Y | 213EG0000X | General Practice | 36323 | TX |
NPI | 1003424920 |
---|---|
Provider Name | Dr. Warren Kritsanachaiwanich |
First Address | Leander, TX 78641-3899 |
Second Address | Austin, TX 78745-1642 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2020 |
Last Update Date | 21/07/2020 |