Provider Demographics
NPI:1134611627
Name:KITTIKASAMSAWAT, NUTTAPONG
Entity type:Individual
Prefix:MR
First Name:NUTTAPONG
Middle Name:
Last Name:KITTIKASAMSAWAT
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 1:6376 YUCCA ST STE B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-5037
Mailing Address - Country:US
Mailing Address - Phone:323-468-2555
Mailing Address - Fax:
Practice Address - Street 1:6376 YUCCA ST STE B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-5037
Practice Address - Country:US
Practice Address - Phone:323-468-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker