Healthcare Provider Details

I. General information

NPI: 1043148406
Provider Name (Legal Business Name): PATTARAPORN TANGTIENCHAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4032 W 184TH ST
TORRANCE CA
90504-4712
US

IV. Provider business mailing address

4032 W 184TH ST
TORRANCE CA
90504-4712
US

V. Phone/Fax

Practice location:
  • Phone: 424-888-9736
  • Fax:
Mailing address:
  • Phone: 424-888-9736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number77596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: