KRIENGSAK ITSARA (NPI# 1558363739) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558363739 |
| Entity Type | Individual |
| Full Name | KRIENGSAK ITSARA |
| Other Name | KRIENGSAK ITSARAYOUNGYUEN |
| Credential | MD |
| Practice Address |
305 E Granger Ave Ste 202 Modesto CA 95350-4344 |
| Practice Telephone | 2065261606 |
| Practice Fax Number | 2095261677 |
| Mailing Telephone | 2065261606 |
| Mailing Fax Number | 2095261677 |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2008-02-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
A33103 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00A331030 | 05 |
| Street Address |
305 E GRANGER AVE STE 202 |
| City | MODESTO |
| State | CA |
| Zip Code | 95350-4344 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669657805 | Modesto Kidney Center, LLC | Clinic/Center | 305 E Granger Ave, Modesto, CA 95350-4345 | 2008-01-07 |
| 1629161336 | Tong Sun | Internal Medicine | 305 E Granger Ave, Ste 202, Modesto, CA 95350-4345 | 2006-10-02 |
| 1003887712 | Modesto Kidney Center, Inc. | Clinic/Center | 305 E Granger Ave, Modesto, CA 95350-4345 | 2006-01-30 |
| 1326042391 | Kenneth K Liu | Internal Medicine | 305 E Granger Ave, Ste 202, Modesto, CA 95350-4344 | 2005-06-08 |
| 1306848569 | Modesto Kidney Medical Group | Internal Medicine | 305 E Granger Ave, Ste 202, Modesto, CA 95350-4344 | 2005-06-01 |
| 1508868787 | Chang S Joo | Internal Medicine | 305 E Granger Ave, Ste 202, Modesto, CA 95350-4344 | 2005-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164020459 | Karina Montes Rodriguez | Case Manager/Care Coordinator | Cip 1540 Florida Ave, Suite 212, Modesto, CA 95350 | 2020-10-09 |
| 1134737315 | Dr. Jeffrey A. Saladin, Dental Corporation | Dentist | 2057 Tully Road, Suite A, Modesto, CA 95350 | 2020-07-14 |
| 1588211254 | Karla Junuen Toscano | Licensed Vocational Nurse | 1235 Mchenry Ave. Suites A&b, Modesto, CA 95350 | 2019-08-19 |
| 1831694769 | Loretta Myers-weber | Nurse Practitioner | 1510 Florida Ave Ste A, Modesto, CA 95350 | 2018-03-23 |
| 1720599632 | Coral Alejandra Amador | Counselor | 1700 Mchenry Village Way, Suite 11b, Modesto, CA 95350 | 2017-10-18 |
| 1053820522 | Pannu and Henne Dental Corp. | Dentist | 3219 Mc Henry Ave, Suite E, Modesto, CA 95350 | 2017-09-27 |
| 1346779709 | Kevin Sotelo | Behavior Technician | 2630 W Rumble Road, Modesto, CA 95350 | 2017-06-08 |
| 1255869566 | Hoa Xuan Phan | Family Medicine | 1441 Florida Ave Ste 200, Modesto, CA 95350 | 2017-05-31 |
| 1356881163 | Brady S Marshall | Dentist | 201 E. Orangeburg Avenue, Suite C, Modesto, CA 95350 | 2017-02-27 |
| 1750755476 | Caremore Health Plan | Nurse Practitioner | 1234 Mchenry Avenue, Modesto, CA 95350 | 2015-11-18 |
| Find all providers in zip 95350 | ||||
| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740588680 | Yuqiang Ge | Internal Medicine | 305 E Granger Ave, Ste 202, Modesto, CA 95350 | 2011-03-01 |
| 1548223480 | Josephine R Baisac | Internal Medicine | 608 E Orangeburg Ave, Modesto, CA 95350-5513 | 2006-04-11 |
| 1073517751 | Kishore K. Kalluri | Internal Medicine | 600 Coffee Rd, Modesto, CA 95355-4201 | 2005-06-09 |
| 1053654343 | Nadia Yousef | Internal Medicine | 600 Coffee Rd, Modesto, CA 95355-4201 | 2013-04-04 |
| 1770738825 | Ravikiran Vegasana | Internal Medicine | 608 E Orangeburg Ave, Modesto, CA 95350-5513 | 2008-11-17 |
| 1659537264 | Mark T. Fahlen, Md, Inc. A Professional Medical Corporation | Internal Medicine | 1400 Florida Ave, Suite 109, Modesto, CA 95350-4422 | 2008-08-03 |
| 1114063716 | Dennis Y. Wu | Internal Medicine | 4601 Dale Rd, Modesto, CA 95356-9718 | 2007-01-30 |
| 1609926427 | Mohit Shahani | Internal Medicine | 4601 Dale Rd, Modesto, CA 95356-9718 | 2007-01-12 |
| 1629161336 | Tong Sun | Internal Medicine | 305 E Granger Ave, Ste 202, Modesto, CA 95350-4345 | 2006-10-02 |
| 1033145800 | Ronak Chandrakant Shah | Internal Medicine | 600 Coffee Rd, Modesto, CA 95355-4201 | 2006-06-24 |
| Find all providers in MODESTO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.