Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 83256 | GA |
NPI | 1669891636 |
---|---|
Provider Name | Kristine Vanijcharoenkarn |
First Address | Atlanta, GA 30322-1020 |
Second Address | Atlanta, GA 30322-1059 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2014 |
Last Update Date | 03/07/2019 |