Provider Demographics
NPI:1740095686
Name:FREEMAN, PIKUNJIT DONKONCHUM (CMT)
Entity type:Individual
Prefix:
First Name:PIKUNJIT
Middle Name:DONKONCHUM
Last Name:FREEMAN
Suffix:
Gender:
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7841 BALBOA AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-2313
Mailing Address - Country:US
Mailing Address - Phone:619-876-8033
Mailing Address - Fax:
Practice Address - Street 1:7841 BALBOA AVE STE 204
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2313
Practice Address - Country:US
Practice Address - Phone:619-876-8033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86072225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist