Provider Demographics
NPI:1558445767
Name:ATHIPRAYOON, CHONTHIDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHONTHIDA
Middle Name:
Last Name:ATHIPRAYOON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 110053
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95011-0053
Mailing Address - Country:US
Mailing Address - Phone:408-260-8283
Mailing Address - Fax:
Practice Address - Street 1:1101 S WINCHESTER BLVD STE E158
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3903
Practice Address - Country:US
Practice Address - Phone:408-260-8283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA395961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice