Provider Demographics
NPI:1417192089
Name:UNNWONGSE, KANJANA (MD)
Entity Type:Individual
Prefix:
First Name:KANJANA
Middle Name:
Last Name:UNNWONGSE
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 1:12000 FAIRHILL RD
Mailing Address - Street 2:APT#818
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1035
Mailing Address - Country:US
Mailing Address - Phone:216-707-1953
Mailing Address - Fax:
Practice Address - Street 1:THE CLEVELAND CLINIC FOUNDATION S10
Practice Address - Street 2:9500 EUCLID AVENUE
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-8040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ246732084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
EHP03338900OtherCLEVELAND CLINIC HEALTH SYSTEM/ EMPLOYEE HEALTH PLAN