Healthcare Provider Details

I. General information

NPI: 1215043419
Provider Name (Legal Business Name): SUNTHORN SUMETHASORN II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 TELSTAR AVE STE 226
EL MONTE CA
91731-2849
US

IV. Provider business mailing address

18 E PALM DR
ARCADIA CA
91006-5136
US

V. Phone/Fax

Practice location:
  • Phone: 626-569-6013
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA053386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: