Provider Demographics
NPI:1871844571
Name:KEODOUANGDY, BAYKHAM (AAS BUSINESS M)
Entity Type:Individual
Prefix:MR
First Name:BAYKHAM
Middle Name:
Last Name:KEODOUANGDY
Suffix:
Gender:M
Credentials:AAS BUSINESS M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8130 OLD SEWARD HWY
Mailing Address - Street 2:UNIT 103
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-3358
Mailing Address - Country:US
Mailing Address - Phone:907-929-5826
Mailing Address - Fax:907-929-5862
Practice Address - Street 1:8130 OLD SEWARD HWY
Practice Address - Street 2:UNIT 103
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-3358
Practice Address - Country:US
Practice Address - Phone:907-929-5826
Practice Address - Fax:907-929-5862
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker