Provider Demographics
NPI:1598843468
Name:PHUNGRASAMEE, VICHAI (MD)
Entity Type:Individual
Prefix:DR
First Name:VICHAI
Middle Name:
Last Name:PHUNGRASAMEE
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 1:334 S PATTERSON AVE
Mailing Address - Street 2:SUITE # 140
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2400
Mailing Address - Country:US
Mailing Address - Phone:805-967-3432
Mailing Address - Fax:805-967-9893
Practice Address - Street 1:334 S PATTERSON AVE
Practice Address - Street 2:SUITE # 140
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2400
Practice Address - Country:US
Practice Address - Phone:805-967-3432
Practice Address - Fax:805-967-9893
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32127208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA3212700Medicaid
CAA3212700Medicaid