Provider Demographics
NPI:1336118504
Name:KUANGPARICHAT, MANOCH (MD)
Entity Type:Individual
Prefix:
First Name:MANOCH
Middle Name:
Last Name:KUANGPARICHAT
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 1:1205 N JESSE JAMES ROAD
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64024-1118
Mailing Address - Country:US
Mailing Address - Phone:816-630-5554
Mailing Address - Fax:816-630-8208
Practice Address - Street 1:1205 N JESSE JAMES ROAD
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-1118
Practice Address - Country:US
Practice Address - Phone:816-630-5554
Practice Address - Fax:816-630-8208
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5579207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C51814Medicare UPIN
0003196Medicare ID - Type Unspecified