Provider Demographics
NPI:1346979598
Name:BOUPAPANH, KESANY
Entity type:Individual
Prefix:
First Name:KESANY
Middle Name:
Last Name:BOUPAPANH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17201 INTERSTATE 45 S
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77385-3311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17201 INTERSTATE 45 S
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77385-3311
Practice Address - Country:US
Practice Address - Phone:936-270-2099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-05
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125080160207R00000X
TXV7457207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine