Provider Demographics
NPI:1982698007
Name:VIBUL TANGPRAPHAPHORN M.D., INC
Entity Type:Organization
Organization Name:VIBUL TANGPRAPHAPHORN M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VIBUL
Authorized Official - Middle Name:
Authorized Official - Last Name:TANGPRAPHAPHORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-765-4124
Mailing Address - Street 1:109 ADKISSON WAY
Mailing Address - Street 2:
Mailing Address - City:TAFT
Mailing Address - State:CA
Mailing Address - Zip Code:93268-3600
Mailing Address - Country:US
Mailing Address - Phone:661-765-4124
Mailing Address - Fax:661-765-6498
Practice Address - Street 1:109 ADKISSON WAY
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:CA
Practice Address - Zip Code:93268-3600
Practice Address - Country:US
Practice Address - Phone:661-765-4124
Practice Address - Fax:661-765-6498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAT8556827OtherDEA
CAA27168Medicare UPIN