Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | C140364 | CA |
NPI | 1245277730 |
---|---|
Provider Name | Mr. Chokechai Rongkavilit |
First Address | Fresno, CA 93721-1431 |
Second Address | Clovis, CA 93611-6886 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 02/05/2019 |