Provider Demographics
NPI:1407304934
Name:CHOKDEE, UMAPORN
Entity Type:Individual
Prefix:
First Name:UMAPORN
Middle Name:
Last Name:CHOKDEE
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 1:1305 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3927
Mailing Address - Country:US
Mailing Address - Phone:612-721-4003
Mailing Address - Fax:
Practice Address - Street 1:1305 E 24TH ST
Practice Address - Street 2:2
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3927
Practice Address - Country:US
Practice Address - Phone:612-721-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 202256-5251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health