Provider Demographics
NPI:1063799740
Name:AMORNPONGCHAI, AUNYAPORN (AUD)
Entity type:Individual
Prefix:
First Name:AUNYAPORN
Middle Name:
Last Name:AMORNPONGCHAI
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:
Other - Last Name:AMORNPONGCHAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:3601 PACIFIC AVENUE
Mailing Address - Street 2:AUDIOLOGY DEPARTMENT
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95211
Mailing Address - Country:US
Mailing Address - Phone:209-946-7378
Mailing Address - Fax:
Practice Address - Street 1:3601 PACIFIC AVENUE
Practice Address - Street 2:AUDIOLOGY DEPARTMENT
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95211
Practice Address - Country:US
Practice Address - Phone:209-946-7378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2785231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist