Provider Demographics
NPI:1184826356
Name:TIENGBURANATARM, KORSIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KORSIN
Middle Name:
Last Name:TIENGBURANATARM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 S KUKUI ST # D1207
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2328
Mailing Address - Country:US
Mailing Address - Phone:607-437-2531
Mailing Address - Fax:
Practice Address - Street 1:347 N KUAKINI ST # HPM-9
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2336
Practice Address - Country:US
Practice Address - Phone:808-523-8461
Practice Address - Fax:808-528-1897
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program