Individual
DR. NIKOM WANNARACHUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
721 S AUBURN ST, KENNEWICK, WA 99336-5665
(509) 586-1157
(509) 582-4189
Mailing address
721 S AUBURN ST, KENNEWICK, WA 99336-5665
(509) 586-1157
(509) 582-4189
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD00012028
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1915008
—
WA
Enumeration date
09/22/2006
Last updated
07/09/2007
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