Individual
DR. KRISNA CHONGSIRIWATANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 WALTER NE, SUITE 104, ALBUQUERQUE, NM 87102
(505) 848-3730
Mailing address
500 WALTER ST NE, SUITE 104, ALBUQUERQUE, NM 87102-2534
(505) 848-3730
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
78-15
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2329
—
NM
Enumeration date
03/24/2006
Last updated
04/27/2012
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