KITIMA BOONVISUDHI

NPI: 1134198005 · Individual · Active

Primary Specialty

Surgery Physician
Surgery

Practice Location

400 HICKORY ST NW STE 101
ALBANY, OR 97321-1700 Map ↗
Phone: 541-812-3360

Mailing Address

PO BOX 1189
CORVALLIS, OR 97339-1189 Map ↗

Used for billing & correspondence; clinical visits at the Practice Location above.

All Specialties & Licenses

  • Surgery Physician Primary (license: MD167013, OR)
  • Surgery Physician (license: 59966, WI)
  • Surgery Physician (license: 204411, NY)

Other Practice Locations

2901 W Kinnickinnic River Pkwy
Ste 311
Milwaukee, WI 53215-3677 Map ↗
Phone: 414-385-8723

HIE Endpoints

  • DIRECT: kboonvisudhi287822@samhealth.direct-ci.com

NPI Registration

Enumerated: 2006-03-14

Last CMS Update: 2025-01-27