Healthcare Provider Details

I. General information

NPI: 1982959243
Provider Name (Legal Business Name): ANNAPOORANI THENAPPAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E CESAR E CHAVEZ AVE # 128
LOS ANGELES CA
90033-2464
US

IV. Provider business mailing address

1701 E CESAR E CHAVEZ AVE # 128
LOS ANGELES CA
90033-2464
US

V. Phone/Fax

Practice location:
  • Phone: 323-223-2338
  • Fax: 323-225-2340
Mailing address:
  • Phone: 323-223-2338
  • Fax: 323-225-2340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA63969
License Number StateCA

VIII. Authorized Official

Name: DR. ANNAPOORANI THENAPPAN
Title or Position: PRESIDENT
Credential: M.D
Phone: 323-223-2338