Provider Demographics
NPI:1063009975
Name:TEP-ON, YANAKARN
Entity Type:Individual
Prefix:
First Name:YANAKARN
Middle Name:
Last Name:TEP-ON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13600 BRETON RIDGE ST UNIT 9C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-5983
Mailing Address - Country:US
Mailing Address - Phone:346-290-8420
Mailing Address - Fax:
Practice Address - Street 1:13600 BRETON RIDGE ST UNIT 9C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5983
Practice Address - Country:US
Practice Address - Phone:346-290-8420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-26
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT134210225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist