Provider Demographics
NPI:1407831662
Name:RANSIBRAHMANAKUL, KANAT (MD)
Entity Type:Individual
Prefix:
First Name:KANAT
Middle Name:
Last Name:RANSIBRAHMANAKUL
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 1:1580 CREEKSIDE DR STE 220
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3888
Mailing Address - Country:US
Mailing Address - Phone:916-983-4444
Mailing Address - Fax:
Practice Address - Street 1:1580 CREEKSIDE DR STE 220
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3888
Practice Address - Country:US
Practice Address - Phone:916-983-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA066312207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH15624Medicare UPIN