Provider Demographics
NPI:1467002410
Name:UNGPHAKORN, TATIYA (DDS, ABO)
Entity Type:Individual
Prefix:DR
First Name:TATIYA
Middle Name:
Last Name:UNGPHAKORN
Suffix:
Gender:F
Credentials:DDS, ABO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E 22ND ST APT 9M
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4821
Mailing Address - Country:US
Mailing Address - Phone:646-496-6696
Mailing Address - Fax:
Practice Address - Street 1:122 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6716
Practice Address - Country:US
Practice Address - Phone:718-852-4414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0606531223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics