Individual
VONGSAVANH TED PHIMSIPRASOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
5500 E KELLOGG DR, WICHITA, KS 67218-1607
(316) 803-2356
(316) 469-0815
Mailing address
11436 E PINE MEADOW CT, WICHITA, KS 67206-7202
(316) 992-7290
(316) 469-0815
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
112882
KS
Other
Enumeration date
07/05/2023
Last updated
07/05/2023
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