Provider Demographics
NPI:1346288065
Name:MORKJAROENPONG, VILASINEE (MD)
Entity Type:Individual
Prefix:DR
First Name:VILASINEE
Middle Name:
Last Name:MORKJAROENPONG
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 1:20932 BROOKHURST ST 105
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-6686
Mailing Address - Country:US
Mailing Address - Phone:714-962-2497
Mailing Address - Fax:714-962-2537
Practice Address - Street 1:20932 BROOKHURST ST
Practice Address - Street 2:105
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-6638
Practice Address - Country:US
Practice Address - Phone:714-962-2497
Practice Address - Fax:714-962-2537
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76702207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H83392Medicare UPIN
CACA694ZMedicare PIN