Provider Demographics
NPI:1629768817
Name:ONGSUPANKUL, SORAWIT
Entity Type:Individual
Prefix:MR
First Name:SORAWIT
Middle Name:
Last Name:ONGSUPANKUL
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 1:1356 LUSITANA ST. 7TH FLOOR,
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-586-2898
Mailing Address - Fax:877-290-7417
Practice Address - Street 1:1356 LUSITANA ST. 7TH FLOOR,
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-586-2898
Practice Address - Fax:877-290-7417
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2024-01-02
Deactivation Date:2023-12-18
Deactivation Code:
Reactivation Date:2024-01-02
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program