Healthcare Provider Details

I. General information

NPI: 1740661206
Provider Name (Legal Business Name): MS. NOPPAMAS KANTIYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 06/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9478 W OLYMPIC BLVD SUITE 307
BEVERLY HILLS CA
90212-4246
US

IV. Provider business mailing address

8711 BURTON WAY #210
WEST HOLLYWOOD CA
90048-3841
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-2099
  • Fax:
Mailing address:
  • Phone: 310-227-1398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number16487
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: