Provider Demographics
NPI:1356017792
Name:CHANYAEM, MANUSANEE
Entity Type:Individual
Prefix:
First Name:MANUSANEE
Middle Name:
Last Name:CHANYAEM
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 1:1123 VINE ST STE 6B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-1670
Mailing Address - Country:US
Mailing Address - Phone:323-747-0987
Mailing Address - Fax:
Practice Address - Street 1:8157 COLDWATER CANYON AVE
Practice Address - Street 2:
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-1129
Practice Address - Country:US
Practice Address - Phone:323-578-3632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC19139171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist