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General NPI Number Information
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NPI Number | 1114062361
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Entity Type | Organization
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Legal Business Name | SITTIPORN BOONTUNG, M.D. INC.
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 23000 CRENSHAW BLVD SUITE 200
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City | TORRANCE
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State | CA
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Zip | 90505-3052
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Country | US
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Telephone | 310-530-6264
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Fax | 310-530-0709
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Provider Business Mailing Address
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Address Line | 23000 CRENSHAW BLVD SUITE 200
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City | TORRANCE
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State | CA
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Zip | 90505-3052
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Country | US
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Telephone | 310-530-6264
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Fax | 310-530-0709
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Authorized Official
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Title or Position | PHYSICIAN
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Name | SITTIPORN BOONTUNG
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Credential | M.D.
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Telephone | 310-530-6264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A25148
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License Number State | CA
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