Provider Demographics
NPI:1740661206
Name:KANTIYA, NOPPAMAS
Entity type:Individual
Prefix:MS
First Name:NOPPAMAS
Middle Name:
Last Name:KANTIYA
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 1:8711 BURTON WAY
Mailing Address - Street 2:#210
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-3841
Mailing Address - Country:US
Mailing Address - Phone:310-227-1398
Mailing Address - Fax:
Practice Address - Street 1:9478 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 307
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4246
Practice Address - Country:US
Practice Address - Phone:310-652-2099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16487171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist