Provider Demographics
NPI:1558595496
Name:SUWANGOMOLKUL, ARISARA (MD)
Entity Type:Individual
Prefix:DR
First Name:ARISARA
Middle Name:
Last Name:SUWANGOMOLKUL
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:PO BOX 6789
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95927-6789
Mailing Address - Country:US
Mailing Address - Phone:530-892-2300
Mailing Address - Fax:530-894-5890
Practice Address - Street 1:285 COHASSET RD
Practice Address - Street 2:STE 100
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-5513
Practice Address - Country:US
Practice Address - Phone:530-892-2300
Practice Address - Fax:530-894-5890
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247533-1207RN0300X
CAA112389207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1558595496Medicaid
CA1558595496Medicaid