Deena Vichugsananon, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD60366262 Issued in WA

Practice address

2320 Freeway Dr
Pediatrics
Mount Vernon, WA 98273-5445

Phone

(360) 814-6870

Fax

(360) 814-6922

NPI assigned

Jun 7, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490054400000",
    "number": "1558564617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 E KINCAID ST",
            "address_2": "ATTN: CREDENTIALING",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744127",
            "telephone_number": "360-428-2500",
            "fax_number": "360-428-6485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2320 FREEWAY DR",
            "address_2": "PEDIATRICS",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982735445",
            "telephone_number": "360-814-6870",
            "fax_number": "360-814-6922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICHUGSANANON",
        "first_name": "DEENA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-07",
        "last_updated": "2017-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD60366262",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2028010",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Mount Vernon, WA
• Providers in Mount Vernon, WA by specialty
• Pediatrics Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.