Provider Demographics
NPI:1467013672
Name:ARISARACHAI, KITTIYA (PA-C)
Entity Type:Individual
Prefix:
First Name:KITTIYA
Middle Name:
Last Name:ARISARACHAI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 PROCTOR RD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-4316
Mailing Address - Country:US
Mailing Address - Phone:626-233-1663
Mailing Address - Fax:
Practice Address - Street 1:21 PROCTOR RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-4316
Practice Address - Country:US
Practice Address - Phone:626-233-1663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant