NPI 1245019298

Sounthala Chandravongsri

Practitioner Driver Portland, OR

Practice location

Address: 4784 N Lombard St STE B, Portland, OR 97203-4565
Phone: (971) 200-1668

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X

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Registry record

NPI: 1245019298
Entity type: Individual
Sex (as registered): Male
NPI issued: 27 Sep 2023
Record last updated: 27 Sep 2023

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.