Healthcare Provider Details

I. General information

NPI: 1073424123
Provider Name (Legal Business Name): MOT DHANAPRASIDHIKUL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S HILL ST
LOS ANGELES CA
90012-3506
US

IV. Provider business mailing address

28315 WELFLEET LN
SANTA CLARITA CA
91350-3964
US

V. Phone/Fax

Practice location:
  • Phone: 213-435-0536
  • Fax:
Mailing address:
  • Phone: 661-593-0530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: