Provider Demographics
NPI:1114972635
Name:PANDEJPONG, DENLA (MD)
Entity Type:Individual
Prefix:DR
First Name:DENLA
Middle Name:
Last Name:PANDEJPONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229/2 PETKASEM102 ROAD
Mailing Address - Street 2:BANGKAENURE, BANGKAE
Mailing Address - City:BANGKOK
Mailing Address - State:BANGKOK
Mailing Address - Zip Code:10160
Mailing Address - Country:TH
Mailing Address - Phone:662-809-1805
Mailing Address - Fax:662-421-5560
Practice Address - Street 1:229/2 PETKASEM102 ROAD
Practice Address - Street 2:BANGKAENURE, BANGKAE
Practice Address - City:BANGKOK
Practice Address - State:BANGKOK
Practice Address - Zip Code:10160
Practice Address - Country:TH
Practice Address - Phone:662-809-1805
Practice Address - Fax:662-421-5560
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93929207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA93929OtherMEDICAL LICENSE
CABP9634759OtherDEA CERT