Individual
DR. KRAIVIT ANGSUPANICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
801 11TH ST, SUITE 1, LAKEPORT, CA 95453-4100
(707) 262-5568
(707) 263-6888
Mailing address
801 11TH ST, SUITE 1, LAKEPORT, CA 95453-4100
(707) 262-5568
(707) 263-6888
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
A34208
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020049565
RAILROAD MEDICARE
CA
Enumeration date
09/20/2006
Last updated
09/17/2008
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