Provider Demographics
NPI:1831740661
Name:BANGSRIWONG, CHIRAPHORN
Entity type:Individual
Prefix:
First Name:CHIRAPHORN
Middle Name:
Last Name:BANGSRIWONG
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 1:13035 TOM WHITE WAY STE L
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-8961
Mailing Address - Country:US
Mailing Address - Phone:626-400-8666
Mailing Address - Fax:
Practice Address - Street 1:5567 RESEDA BLVD STE 219
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2600
Practice Address - Country:US
Practice Address - Phone:626-400-8666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18603171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist