Provider Demographics
NPI:1942318340
Name:PAJONG, SOMKIET (DO)
Entity Type:Individual
Prefix:DR
First Name:SOMKIET
Middle Name:
Last Name:PAJONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:MR
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:PAJONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9089 BASLINE ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730
Mailing Address - Country:US
Mailing Address - Phone:909-483-0505
Mailing Address - Fax:909-483-0508
Practice Address - Street 1:9089 BASLINE ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:909-483-0505
Practice Address - Fax:909-483-0508
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6268207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I43365Medicare UPIN
CA020A62680Medicare ID - Type Unspecified