Provider Demographics
NPI:1962727123
Name:PHAOSAWASDI, PIANGWARIN (MD)
Entity type:Individual
Prefix:DR
First Name:PIANGWARIN
Middle Name:
Last Name:PHAOSAWASDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PIANGWARIN
Other - Middle Name:
Other - Last Name:KENKASUMART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1360 BURTON DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-3557
Mailing Address - Country:US
Mailing Address - Phone:707-446-4379
Mailing Address - Fax:707-446-4417
Practice Address - Street 1:1360 BURTON DR
Practice Address - Street 2:SUITE 160
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687
Practice Address - Country:US
Practice Address - Phone:707-446-4379
Practice Address - Fax:707-446-4417
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA124444208M00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA155950Medicare PIN