Healthcare Provider Details

I. General information

NPI: 1144674003
Provider Name (Legal Business Name): JOHN THANASUKARN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8530 FIRESTONE BLVD
DOWNEY CA
90241-4926
US

IV. Provider business mailing address

54701 FILE NUMBER
LOS ANGELES CA
90074-4701
US

V. Phone/Fax

Practice location:
  • Phone: 562-867-7999
  • Fax:
Mailing address:
  • Phone: 96-514-3009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA156685
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: