Individual
DR. KANOKRAT SUKSOMPOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
255 E BONITA AVE BLDG 1B, POMONA, CA 91767-1923
(909) 275-7470
(909) 971-4532
Mailing address
310 N INDIAN HILL BLVD, PMB 801, CLAREMONT, CA 91711-4611
(909) 275-7470
(909) 971-4532
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35749
AZ
207RI0200X
Infectious Disease Physician
Primary
A96983
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
117346
HEALTH CHOICE OF AZ
AZ
05
—
117346
—
AZ
01
—
2Z7810
HEALTH NET OF AZ
AZ
01
—
7789806
AETNA
AZ
Enumeration date
08/09/2006
Last updated
09/03/2019
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