Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | MD028-531L | PA |
NPI | 1013358084 |
---|---|
Provider Name | Mr. Kamthorn Sukarochana |
First Address | Pittsburgh, PA 15237 |
Second Address | Pittsburgh, PA 15237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2013 |
Last Update Date | 08/07/2013 |