Provider Demographics
NPI:1912152737
Name:JAIJAKUL, SIRAYA (MD)
Entity type:Individual
Prefix:
First Name:SIRAYA
Middle Name:
Last Name:JAIJAKUL
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 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 1101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-441-0006
Mailing Address - Fax:713-790-2727
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 1101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-441-0006
Practice Address - Fax:713-790-2727
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1463207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8FW076OtherBCBS
TX3087579-01Medicaid
TX8FW077OtherBCBS
TX308757903Medicaid
TX489384ZSWDMedicare PIN
TXTXB164075Medicare PIN
TX308757903Medicaid