Individual
BUNCHONG KOSOLCHAROEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5196 HILL RD E STE 203, LAKEPORT, CA 95453-6362
(707) 263-6866
(707) 263-0376
Mailing address
PO BOX 1769, LAKEPORT, CA 95453-1769
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
A39985
CA
207RP1001X
Pulmonary Disease Physician
Primary
A39985
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A399850
—
CA
Enumeration date
08/12/2006
Last updated
01/24/2012
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