Basic Information
| Provider Information | |||||||||
| NPI: | 1679738330 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IAMPORNPIPOPCHAI | ||||||||
| FirstName: | PICHET | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 133 ROUTE 3 | ||||||||
| Address2: | |||||||||
| City: | DEDEDO | ||||||||
| State: | GU | ||||||||
| PostalCode: | 96929 | ||||||||
| CountryCode: | UM | ||||||||
| TelephoneNumber: | 6716497232 | ||||||||
| FaxNumber: | 6716497233 | ||||||||
| Practice Location | |||||||||
| Address1: | 133 ROUTE 3 | ||||||||
| Address2: | |||||||||
| City: | DEDEDO | ||||||||
| State: | GU | ||||||||
| PostalCode: | 96929 | ||||||||
| CountryCode: | UM | ||||||||
| TelephoneNumber: | 6716455500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2008 | ||||||||
| LastUpdateDate: | 05/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | M-1773 | GU | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 208M00000X | M-1773 | GU | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.