Supakanya Wongrakpanich, M.D

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A153678 Issued in CA

Practice address

25455 Barton Rd Ste 204B
Loma Linda, CA 92354-3130

Phone

(909) 958-6600

NPI assigned

Jun 29, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1404000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647907200000",
    "number": "1568877413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FILE # 54701",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900744701",
            "telephone_number": "909-651-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25455 BARTON RD STE 204B",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543130",
            "telephone_number": "909-958-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONGRAKPANICH",
        "first_name": "SUPAKANYA",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-29",
        "last_updated": "2022-03-22",
        "certification_date": "2022-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MT206363",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A153678",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INTERNAL MEDICINE",
            "identifier": "-",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Raymond Wong, M.D.
• Samantha Hein Wong, NP
• Timothy Philip Wong, DO
• Valarie Y Wong, M.D.
• Vincent Kah Wong, MD
• Montri D Wongworawat, M.D.
• Wongyun Jeung DDS Inc
• Jeffrey Wonoprabowo, M.D.
• Hedy Woo
• Michael Woo, M.D.

• Internal Medicine Physician in Loma Linda, CA
• Providers in Loma Linda, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2022; 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.