Healthcare Provider Details

I. General information

NPI: 1295536670
Provider Name (Legal Business Name): PRAPAPIM THUMMONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 BENNETT AVE APT 304
LONG BEACH CA
90804-5928
US

IV. Provider business mailing address

1225 BENNETT AVE APT 304
LONG BEACH CA
90804-5928
US

V. Phone/Fax

Practice location:
  • Phone: 424-491-6395
  • Fax:
Mailing address:
  • Phone: 424-491-6395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number96134
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: