Individual
MR. SOUNTHALA CHANDRAVONGSRI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4784 N LOMBARD ST STE B, PORTLAND, OR 97203-4565
(971) 200-1668
Mailing address
4784 N LOMBARD ST STE B, PORTLAND, OR 97203-4565
(971) 200-1668
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
09/27/2023
Last updated
09/27/2023
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