MEDICARE: KOCHAKORN KONGKAEW KUS

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	225700000X	Massage Therapist	83555	CA

General Provider Information

NPI Number	:	1629923180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KOCHAKORN KONGKAEW KUS

Provider Business Mailing Address
First Line	:	5346 LOMA LINDA AVE APT 201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-3691
Country	:	US
Telephone Number	:	818-296-8597
Fax Number	:

Provider Business Practice Location Address
First Line	:	5346 LOMA LINDA AVE APT 201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-3691
Country	:	US
Telephone Number	:	818-296-8597
Fax Number	:

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

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/04/2026

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Directions to “ KOCHAKORN KONGKAEW KUS ” Practice Location

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