Healthcare Provider Details

I. General information

NPI: 1457200792
Provider Name (Legal Business Name): MR. PATTARADANAI CHAIYAKOT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2343 MARKET ST
SAN FRANCISCO CA
94114-1617
US

IV. Provider business mailing address

1709 GRAND ST UNIT A
ALAMEDA CA
94501-1221
US

V. Phone/Fax

Practice location:
  • Phone: 415-874-9895
  • Fax:
Mailing address:
  • Phone: 424-653-9415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number90461
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: