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General NPI Number Information
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NPI Number | 1366223885
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Entity Type | Individual
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Provider Name | SUPIYANUN CHONGOLNEE
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Gender | Female
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Dates
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Enumeration Date | 10/10/2023
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 8455 BEVERLY BLVD STE 507
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City | LOS ANGELES
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State | CA
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Zip | 90048-3445
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Country | US
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Telephone | 818-292-4919
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Fax |
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Provider Business Mailing Address
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Address Line | 421 S LA FAYETTE PARK PL APT 230
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City | LOS ANGELES
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State | CA
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Zip | 90057-1694
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Country | US
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Telephone | 818-292-4919
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 15736
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License Number State | CA
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