Provider Demographics
NPI:1417398744
Name:ANONGCHANYA, PRINYAPORN
Entity Type:Individual
Prefix:
First Name:PRINYAPORN
Middle Name:
Last Name:ANONGCHANYA
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 1:7235 BAIRD AVE
Mailing Address - Street 2:APT 206
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-3069
Mailing Address - Country:US
Mailing Address - Phone:818-632-7481
Mailing Address - Fax:
Practice Address - Street 1:7235 BAIRD AVE
Practice Address - Street 2:APT 206
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-3069
Practice Address - Country:US
Practice Address - Phone:818-632-7481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program