Individual
DR. ANDY KEITH KONGSAKUL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
19636 SHERMAN WAY, RESEDA, CA 91335-3647
(818) 774-2020
(818) 774-2021
Mailing address
19636 SHERMAN WAY, RESEDA, CA 91335-3647
(818) 774-2020
(818) 774-2021
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
13639T
CA
152W00000X
Optometrist
Primary
TUV007213-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649400920
—
CA
Enumeration date
09/04/2007
Last updated
01/05/2022
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