Provider Demographics
NPI:1700873023
Name:PICHAKRON, KULLADA (MD)
Entity Type:Individual
Prefix:DR
First Name:KULLADA
Middle Name:
Last Name:PICHAKRON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7056 BROWNS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-9353
Mailing Address - Country:US
Mailing Address - Phone:707-451-1135
Mailing Address - Fax:
Practice Address - Street 1:60 MSGS/SGCQ
Practice Address - Street 2:101 BODIN CIRCLE
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-1800
Practice Address - Country:US
Practice Address - Phone:707-423-5188
Practice Address - Fax:707-423-7949
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2021-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA92499208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery