Provider Demographics
NPI:1205462314
Name:CHOOCHONGKOL, SAJIPHORN
Entity type:Individual
Prefix:
First Name:SAJIPHORN
Middle Name:
Last Name:CHOOCHONGKOL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 RACE TRACK RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-3308
Mailing Address - Country:US
Mailing Address - Phone:240-305-3797
Mailing Address - Fax:
Practice Address - Street 1:1134 MORSE ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3806
Practice Address - Country:US
Practice Address - Phone:202-560-4865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant