Provider Demographics
NPI:1699364679
Name:JATUPARISUTHISEEN, KANOKWAN
Entity Type:Individual
Prefix:
First Name:KANOKWAN
Middle Name:
Last Name:JATUPARISUTHISEEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-2002
Mailing Address - Country:US
Mailing Address - Phone:203-858-4929
Mailing Address - Fax:
Practice Address - Street 1:8 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4201
Practice Address - Country:US
Practice Address - Phone:203-858-4929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT789171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist