Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 24696 | OK |
N | 2080P0210X | Pediatric Nephrologist | 24696 | OK |
N | 2080P0210X | Pediatric Nephrologist | A73758 | CA |
NPI | 1962470294 |
---|---|
Provider Name | Dr. Pornpimol Rianthavorn |
First Address | Oklahoma City, OK 73117-1039 |
Second Address | Oklahoma City, OK 73104-5008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2006 |
Last Update Date | 08/07/2007 |