Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | MD035212L | PA |
NPI | 1295821742 |
---|---|
Provider Name | Vathana O. Bunya |
First Address | Philadelphia, PA 19132-2804 |
Second Address | Philadelphia, PA 19132-2804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0094630304 | (05) | PA |