Provider Demographics
NPI:1154554780
Name:THIPPHAVONG, SENGAROUN (MD)
Entity type:Individual
Prefix:DR
First Name:SENGAROUN
Middle Name:
Last Name:THIPPHAVONG
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 1:303 E 60TH ST
Mailing Address - Street 2:19E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1514
Mailing Address - Country:US
Mailing Address - Phone:917-224-2325
Mailing Address - Fax:
Practice Address - Street 1:303 E 60TH ST
Practice Address - Street 2:19E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1514
Practice Address - Country:US
Practice Address - Phone:917-224-2325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP718532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology