Provider Demographics
NPI:1720534639
Name:SUANTHONG, SURINTORN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SURINTORN
Middle Name:
Last Name:SUANTHONG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5455 N SHERIDAN RD
Mailing Address - Street 2:APT 2103
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1958
Mailing Address - Country:US
Mailing Address - Phone:773-317-7029
Mailing Address - Fax:
Practice Address - Street 1:1335 W LAKE ST
Practice Address - Street 2:CHICAGO TOUCH
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1518
Practice Address - Country:US
Practice Address - Phone:312-929-3083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000762171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist