Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | E3160 | TX |
Y | 208600000X | Surgeon | E3160 | TX |
NPI | 1003823139 |
---|---|
Provider Name | Vradej Chinookoswong |
First Address | Webster, TX 77598-4123 |
Second Address | Webster, TX 77598-4123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 12/07/2007 |