Individual
VATHANA O. BUNYA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2415 N 33RD ST, PHILADELPHIA, PA 19132-2804
(215) 225-6222
(610) 668-3695
Mailing address
2415 N 33RD ST, PHILADELPHIA, PA 19132-2804
(215) 225-6222
(610) 668-3695
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
MD035212L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0094630304
—
PA
Enumeration date
10/04/2006
Last updated
07/08/2007
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