Provider Demographics
NPI:1225364623
Name:THASANA NIVATPUMIN, M.D., INC.
Entity Type:Organization
Organization Name:THASANA NIVATPUMIN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THASANA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIVATPUMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-271-7012
Mailing Address - Street 1:PO BOX 17298
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-3298
Mailing Address - Country:US
Mailing Address - Phone:310-271-7012
Mailing Address - Fax:310-271-7842
Practice Address - Street 1:9301 WILSHIRE BLVD
Practice Address - Street 2:SUITE 602
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-6161
Practice Address - Country:US
Practice Address - Phone:310-271-7012
Practice Address - Fax:310-271-7842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37300207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A373000Medicaid
CA00A373000Medicaid
CAA37300Medicare PIN