Individual
DR. SOMPRAK BOONPONGMANEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8819 W. VICTORIA AVE, KENNEWICK, WA 99336
(509) 460-5500
(509) 460-5111
Mailing address
8819 W. VICTORIA AVE, KENNEWICK, WA 99336
(509) 460-5500
(509) 460-5111
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
MD00042206
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0207386
LABOR AND INDUSTRIES
WA
05
—
8354037
—
WA
01
—
P00289575
RR MEDICARE
—
Enumeration date
11/13/2006
Last updated
06/05/2015
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