{"npi":"1619945524","type":"NPI-1","status":"active","name":{"display":"Sourasack Vongsa MD","other":[],"first":"SOURASACK","last":"VONGSA","middle":"KIT","credential":"MD"},"specialty":{"primary_taxonomy":"207Q00000X","primary_taxonomy_description":"Family Medicine","slug":"family-medicine","schema_org_specialty":"PrimaryCare","all":[{"code":"207Q00000X","description":"Family Medicine","primary":true,"state":"WI","license":"47253"}]},"addresses":[{"purpose":"LOCATION","street_1":"2500 E CAPITOL DR STE 1200","city":"APPLETON","state":"WI","postal_code":"54911","country_code":"US","phone":"9208306877","fax":"8002362236"},{"purpose":"MAILING","street_1":"122 E COLLEGE AVE","city":"APPLETON","state":"WI","postal_code":"549115794","country_code":"US","phone":"9209963264","fax":"9208305970"}],"license":{"state":"WI","number":"47253"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"34808400","state":"WI","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20060106000116","type_code":"14-08","type_desc":"PRACTITIONER - FAMILY PRACTICE","state":"WI","pac_id":"8224051131"}]},"enumeration_date":"2006-03-08","last_updated":"2019-08-19","_meta":{"source":"NPPES","snapshot_date":"2019-08-19","doc_url":"https://findmynpi.com/api"}}