Individual
DR. KITIMA BOONVISUDHI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
400 HICKORY ST NW STE 101, ALBANY, OR 97321-1700
(541) 812-3360
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
204411
NY
208600000X
Surgery Physician
59966
WI
208600000X
Surgery Physician
Primary
MD167013
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02440095
—
NY
Enumeration date
03/14/2006
Last updated
01/27/2025
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