Healthcare Provider Details

I. General information

NPI: 1427897263
Provider Name (Legal Business Name): ANAWIN TUN KITPOWSONG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7031 SW 62ND AVE
SOUTH MIAMI FL
33143-4701
US

IV. Provider business mailing address

7031 SW 62ND AVE
SOUTH MIAMI FL
33143-4701
US

V. Phone/Fax

Practice location:
  • Phone: 305-284-7761
  • Fax:
Mailing address:
  • Phone: 305-284-7761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberOS23816
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOS23816
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: