Provider Demographics
NPI:1912232042
Name:KHIEWKUMPAN, ARIYAWAN (RN)
Entity Type:Individual
Prefix:MS
First Name:ARIYAWAN
Middle Name:
Last Name:KHIEWKUMPAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4016 44TH ST
Mailing Address - Street 2:BASEMENT
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-2109
Mailing Address - Country:US
Mailing Address - Phone:718-473-7714
Mailing Address - Fax:
Practice Address - Street 1:4016 44TH ST
Practice Address - Street 2:BASEMENT
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-2109
Practice Address - Country:US
Practice Address - Phone:718-473-7714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY621581163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse