Provider Demographics
NPI:1407507452
Name:VONGPHRACHANH, KATHERINE ANNE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNE
Last Name:VONGPHRACHANH
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 1:98-360 KOAUKA LOOP APT 220
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4421
Mailing Address - Country:US
Mailing Address - Phone:267-565-7448
Mailing Address - Fax:
Practice Address - Street 1:98-360 KOAUKA LOOP APT 220
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4421
Practice Address - Country:US
Practice Address - Phone:267-565-7448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician