Provider Demographics
NPI:1932474731
Name:VICHAI LOTONGKHUM,M.D.&LEK LOTONGKHUM,M.D.PC
Entity Type:Organization
Organization Name:VICHAI LOTONGKHUM,M.D.&LEK LOTONGKHUM,M.D.PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:LOTONGKHUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-381-2121
Mailing Address - Street 1:361 STOCKHOLM ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-8086
Mailing Address - Country:US
Mailing Address - Phone:718-381-2121
Mailing Address - Fax:718-497-0740
Practice Address - Street 1:361 STOCKHOLM ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-8086
Practice Address - Country:US
Practice Address - Phone:718-381-2121
Practice Address - Fax:718-497-0740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127806261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center