Healthcare Provider Details

I. General information

NPI: 1710840384
Provider Name (Legal Business Name): SYRIPHORN WEELAKORN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 152ND ST
SOUTH SIOUX CITY NE
68776-4515
US

IV. Provider business mailing address

604 152ND ST
SOUTH SIOUX CITY NE
68776-4515
US

V. Phone/Fax

Practice location:
  • Phone: 402-508-0393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: