Healthcare Provider Details

I. General information

NPI: 1366365132
Provider Name (Legal Business Name): MRS. PHORNNATCHA SONGKAEW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 DEL AMO BLVD
TORRANCE CA
90503-1939
US

IV. Provider business mailing address

5900 CENTER DR APT 557
LOS ANGELES CA
90045-8935
US

V. Phone/Fax

Practice location:
  • Phone: 310-800-1418
  • Fax:
Mailing address:
  • Phone: 626-654-2456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number66341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: