Provider Demographics
NPI:1932307626
Name:PIMATUKARNTA, VICHARN (MD)
Entity Type:Individual
Prefix:DR
First Name:VICHARN
Middle Name:
Last Name:PIMATUKARNTA
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 1:13752 HEDDA CIR
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6343
Mailing Address - Country:US
Mailing Address - Phone:562-483-1081
Mailing Address - Fax:
Practice Address - Street 1:FIFTH STREET AT WESTERN
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860
Practice Address - Country:US
Practice Address - Phone:951-273-2371
Practice Address - Fax:951-273-2363
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34926207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease