Provider Demographics
NPI:1932546934
Name:BEST WOUND AND DIABETES CARE INC
Entity Type:Organization
Organization Name:BEST WOUND AND DIABETES CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KHAMPHA
Authorized Official - Middle Name:
Authorized Official - Last Name:THEPHAVONG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:559-226-1284
Mailing Address - Street 1:2205 N FRESNO ST
Mailing Address - Street 2:C
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-2210
Mailing Address - Country:US
Mailing Address - Phone:559-226-1284
Mailing Address - Fax:559-226-1211
Practice Address - Street 1:2205 N FRESNO ST
Practice Address - Street 2:C
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-2210
Practice Address - Country:US
Practice Address - Phone:559-226-1284
Practice Address - Fax:559-226-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA209790207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A9790Medicare Oscar/Certification