Provider Demographics
NPI:1467051078
Name:THEPSUTAM, WARAKORN
Entity Type:Individual
Prefix:MR
First Name:WARAKORN
Middle Name:
Last Name:THEPSUTAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 26TH AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1153
Mailing Address - Country:US
Mailing Address - Phone:415-632-7131
Mailing Address - Fax:
Practice Address - Street 1:270 26TH AVE APT 8
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-1153
Practice Address - Country:US
Practice Address - Phone:415-632-7131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76878225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist