Individual
KRISDA H CHAIYACHATI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD, MPH
Contact information
Practice address
3900 WOODLAND AVE, PHILADELPHIA, PA 19104-4551
(215) 823-5800
Mailing address
423 GUARDIAN DR, 1301 BLOCKLEY HALL, PHILADELPHIA, PA 19104-4865
(215) 573-9328
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
052881
CT
207R00000X
Internal Medicine Physician
Primary
MD453616
PA
Other
Enumeration date
03/29/2011
Last updated
07/21/2015
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