MEDICARE: KANOKPORN MINANOND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1326848490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANOKPORN MINANOND

Provider Business Mailing Address
First Line	:	4923 N LEAVITT ST UNIT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-1308
Country	:	US
Telephone Number	:	312-774-5240
Fax Number	:

Provider Business Practice Location Address
First Line	:	3036 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3539
Country	:	US
Telephone Number	:	773-270-1703
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2025
Last Update Date	:	03/17/2025

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Directions to “ KANOKPORN MINANOND ” Practice Location

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