Provider Demographics
NPI:1710247085
Name:SORNYA PONRARTANA MD INC
Entity Type:Organization
Organization Name:SORNYA PONRARTANA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SORNYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PONRARTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-839-6611
Mailing Address - Street 1:3526 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-3302
Mailing Address - Country:US
Mailing Address - Phone:714-839-6611
Mailing Address - Fax:714-839-6612
Practice Address - Street 1:3526 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-3302
Practice Address - Country:US
Practice Address - Phone:714-839-6611
Practice Address - Fax:714-839-6612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102825208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1567039Medicaid