License holder summary

MANIVANH KEOBOUNNAM is a Graduate Medical Trainee licensed to practice in Pennsylvania. The address on file for MANIVANH KEOBOUNNAM is Philadelphia PA 19107. This medical practitioner license is not current. The license was granted 05/06/2005 and expired on 06/30/2009.

Department of State

Board of Medicine

MANIVANH KEOBOUNNAM
Graduate Medical Trainee
License number
MT185941
Date granted
05/06/2005
Date expires
06/30/2009
Class
Graduate Medical Trainee
Status
Inactive
Address
Philadelphia PA 19107
medicinepa.com
ID 37543517
LAST UPDATED 2026-04-26 17:52:30 UTC

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