Provider Demographics
NPI:1609894385
Name:PRAKALAPAKORN, SIPONG GREG (MD)
Entity Type:Individual
Prefix:DR
First Name:SIPONG
Middle Name:GREG
Last Name:PRAKALAPAKORN
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 1:700 LAWRENCE EXPY
Mailing Address - Street 2:FLOOR 2, DEPT 200
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-5173
Mailing Address - Country:US
Mailing Address - Phone:408-851-6041
Mailing Address - Fax:
Practice Address - Street 1:700 LAWRENCE EXPY
Practice Address - Street 2:FLOOR 2, DEPT 200
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5173
Practice Address - Country:US
Practice Address - Phone:408-851-6041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239566207L00000X
CAA95132207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0006222000 (GROUP)Medicaid
WV0006222000 (GROUP)Medicaid