Provider Demographics
NPI:1912287137
Name:YAMPIKULSAKUL, POJCHAWAN (MD)
Entity Type:Individual
Prefix:
First Name:POJCHAWAN
Middle Name:
Last Name:YAMPIKULSAKUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:POJCHAWAN
Other - Middle Name:
Other - Last Name:YAMPIKULSAKUL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:21 COLUMBIA ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1133
Mailing Address - Country:US
Mailing Address - Phone:321-841-6600
Mailing Address - Fax:321-841-4085
Practice Address - Street 1:21 COLUMBIA ST STE 201
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1133
Practice Address - Country:US
Practice Address - Phone:321-841-6600
Practice Address - Fax:321-841-4085
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME129269207R00000X
NY275638207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021122100Medicaid
FL021122100Medicaid