Provider Demographics
NPI:1225067945
Name:PITIYANUVATH, TASANAPORN (MD)
Entity Type:Individual
Prefix:DR
First Name:TASANAPORN
Middle Name:
Last Name:PITIYANUVATH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 E MEYER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-1121
Mailing Address - Country:US
Mailing Address - Phone:816-753-5144
Mailing Address - Fax:816-777-2796
Practice Address - Street 1:2340 E MEYER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1121
Practice Address - Country:US
Practice Address - Phone:816-753-5144
Practice Address - Fax:816-777-2796
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO33971174400000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201583416Medicaid
MO201583416Medicaid