Healthcare Provider Details

I. General information

NPI: 1326071762
Provider Name (Legal Business Name): MONTHAKAN RATNARATHORN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 09/26/2023
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 FRANCISCO ST
LOS ANGELES CA
90017-2530
US

IV. Provider business mailing address

814 FRANCISCO ST
LOS ANGELES CA
90017-2530
US

V. Phone/Fax

Practice location:
  • Phone: 310-497-5774
  • Fax: 301-491-7071
Mailing address:
  • Phone: 310-497-5774
  • Fax: 301-491-7071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number036135349
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberA68760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: