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Individual
VANIDA WANGWONGVIVAT
Active
Individual
VANIDA WANGWONGVIVAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
07752
IA
122300000X
Dentist
Primary
40903
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B40903
DENTICAL
CA
Enumeration date
07/17/2006
Last updated
10/28/2023
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