Provider Demographics
NPI:1093558801
Name:CHAIMONGKOL, THOMAS (RRT)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:CHAIMONGKOL
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6947 FARMINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-2214
Mailing Address - Country:US
Mailing Address - Phone:916-716-5453
Mailing Address - Fax:
Practice Address - Street 1:6947 FARMINGTON WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-2214
Practice Address - Country:US
Practice Address - Phone:916-716-5453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47719227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered