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General NPI Number Information
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NPI Number | 1225364623
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Entity Type | Organization
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Legal Business Name | THASANA NIVATPUMIN, M.D., INC.
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Dates
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Enumeration Date | 10/20/2009
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Last Update Date | 10/27/2009
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Provider Practice Location Address
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Address Line | 9301 WILSHIRE BLVD SUITE 602
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-6161
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Country | US
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Telephone | 310-271-7012
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Fax | 310-271-7842
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Provider Business Mailing Address
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Address Line | PO BOX 17298
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City | BEVERLY HILLS
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State | CA
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Zip | 90209-3298
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Country | US
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Telephone | 310-271-7012
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Fax | 310-271-7842
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Authorized Official
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Title or Position | PRESIDENT
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Name | THASANA NIVATPUMIN
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Credential | M.D.
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Telephone | 310-271-7012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A37300
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License Number State | CA
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