Provider Demographics
NPI:1689427403
Name:PHUENGSOMBOONYING, BOONDARIK SANDY (MD)
Entity Type:Individual
Prefix:
First Name:BOONDARIK
Middle Name:SANDY
Last Name:PHUENGSOMBOONYING
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 1:11315 ELMHURST DR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-6907
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1135 W UNIVERSITY DR STE 250
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1886
Practice Address - Country:US
Practice Address - Phone:248-650-6301
Practice Address - Fax:248-650-5486
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program