1649301961 NPI number — SITTILERK TRIKALSARANSUKH M.D.

Table of content: SITTILERK TRIKALSARANSUKH M.D. (NPI 1649301961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649301961 NPI number — SITTILERK TRIKALSARANSUKH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRIKALSARANSUKH
Provider First Name:
SITTILERK
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649301961
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7114 W HOOD PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNEWICK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99336-6712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-734-4885
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7114 W HOOD PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-6712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-734-4885
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  MD00031517 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3860TR . This is a "ASURIS NW" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 3860TR . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 51930 . This is a "LABOR AND INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1087543 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5980382 . This is a "AETNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 814193 . This is a "FIRST HLTH CCN COVENTRY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5166927 . This is a "PPNI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9149389 . This is a "PHCS MULTIPLAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 067897 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8927577 . This is a "CRIME VICTIMS UNIT" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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