Provider Demographics
NPI:1093881849
Name:WERASOPHON, SOMCHAI (MD)
Entity Type:Individual
Prefix:DR
First Name:SOMCHAI
Middle Name:
Last Name:WERASOPHON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1282 KINGS CROWN RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-1492
Mailing Address - Country:US
Mailing Address - Phone:714-544-6015
Mailing Address - Fax:714-734-8895
Practice Address - Street 1:1226 E MCFADDEN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4106
Practice Address - Country:US
Practice Address - Phone:714-542-1331
Practice Address - Fax:714-542-4758
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 36566207V00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A365660Medicaid
CAF21163Medicare UPIN