Individual
DEENA VICHUGSANANON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2320 FREEWAY DR, PEDIATRICS, MOUNT VERNON, WA 98273-5445
(360) 814-6870
(360) 814-6922
Mailing address
1400 E KINCAID ST, ATTN: CREDENTIALING, MOUNT VERNON, WA 98274-4127
(360) 428-2500
(360) 428-6485
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD60366262
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2028010
—
WA
Enumeration date
06/07/2007
Last updated
03/21/2017
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