Provider Demographics
NPI:1700198801
Name:BOONYAPUTTHIKUL, ROBERT (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BOONYAPUTTHIKUL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15725 E. WHITTIER BLVD.
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603
Mailing Address - Country:US
Mailing Address - Phone:562-947-1669
Mailing Address - Fax:562-464-5134
Practice Address - Street 1:15725 WHITTIER BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2347
Practice Address - Country:US
Practice Address - Phone:562-947-1669
Practice Address - Fax:562-464-5134
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11849207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine