MEDICARE: DR. KOONLAWEE NADEMANEE M.D.

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	207RC0001X	Clinical Cardiac Electrophysiology Physician	A32891	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699882415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KOONLAWEE NADEMANEE M.D.

Provider Business Mailing Address
First Line	:	P.O. BOX 33679
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-0679
Country	:	US
Telephone Number	:	310-672-9999
Fax Number	:	310-861-0540

Provider Business Practice Location Address
First Line	:	1700 CESAR E. CHAVEZ AVENUE
Second Line	:	SUITE 2700
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-2434
Country	:	US
Telephone Number	:	310-672-9999
Fax Number	:	310-861-0540

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	06/23/2009

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Directions to “ DR. KOONLAWEE NADEMANEE M.D.” Practice Location

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