MEDICARE: KIATTIPOOM NANTANUKUL

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	235Z00000X	Speech-Language Pathologist	2204000843	VA

General Provider Information

NPI Number	:	1447912829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIATTIPOOM NANTANUKUL

Provider Business Mailing Address
First Line	:	680 RHODE ISLAND AVE NE APT 159B
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-1478
Country	:	US
Telephone Number	:	857-296-2354
Fax Number	:

Provider Business Practice Location Address
First Line	:	680 RHODE ISLAND AVE NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-1269
Country	:	US
Telephone Number	:	857-296-2354
Fax Number	:

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

Provider Enumeration Date	:	10/12/2021
Last Update Date	:	10/12/2021

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Directions to “ KIATTIPOOM NANTANUKUL ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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