MEDICARE: KITTAPORN JONGLERTJANYA DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	OT021067	PA

General Provider Information

NPI Number	:	1518538222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KITTAPORN JONGLERTJANYA DO

Provider Business Mailing Address
First Line	:	5929 E PIMA ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-4353
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5929 E PIMA ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-4353
Country	:	US
Telephone Number	:	520-222-9497
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2021
Last Update Date	:	02/09/2026

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