Healthcare Provider Details

I. General information

NPI: 1174697254
Provider Name (Legal Business Name): THIRA KUNAKORN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: THIRAPAN KUNAKORNSKUL

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W LA PALMA AVE STE 6
ANAHEIM CA
92801-2820
US

IV. Provider business mailing address

1120 W LA PALMA AVE #6
ANAHEIM CA
92801-2820
US

V. Phone/Fax

Practice location:
  • Phone: 714-776-6930
  • Fax: 714-776-3345
Mailing address:
  • Phone: 714-776-6930
  • Fax: 714-776-3345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA29554
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA29554
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: