Provider Demographics
NPI:1124137831
Name:VANICHAROEN, YUPIN (MD)
Entity type:Individual
Prefix:DR
First Name:YUPIN
Middle Name:
Last Name:VANICHAROEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:TAFT
Mailing Address - State:CA
Mailing Address - Zip Code:93268-3511
Mailing Address - Country:US
Mailing Address - Phone:661-763-3606
Mailing Address - Fax:661-763-3606
Practice Address - Street 1:400 CENTER ST
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:CA
Practice Address - Zip Code:93268-3511
Practice Address - Country:US
Practice Address - Phone:661-763-3606
Practice Address - Fax:661-763-3606
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42143208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C421430Medicaid
CAA37752Medicare UPIN