Provider Demographics
NPI:1265432207
Name:KRAILAS, WITOON S (MD)
Entity type:Individual
Prefix:MR
First Name:WITOON
Middle Name:S
Last Name:KRAILAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:WITOON
Other - Middle Name:
Other - Last Name:SUDHEERAKRAILAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3839 W 1ST ST
Mailing Address - Street 2:STE B8
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-4075
Mailing Address - Country:US
Mailing Address - Phone:714-554-8966
Mailing Address - Fax:714-554-8988
Practice Address - Street 1:3839 W 1ST ST
Practice Address - Street 2:STE B8
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-4075
Practice Address - Country:US
Practice Address - Phone:714-554-8966
Practice Address - Fax:714-554-8988
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33395207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A333950Medicaid
CA00A333950Medicaid
A33395Medicare ID - Type Unspecified