Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | P89192 | NY |
NPI | 1104268077 |
---|---|
Provider Name | Mr. Thitipong Tepsuwan |
First Address | New York, NY 10029 |
Second Address | New York, NY 10029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2013 |
Last Update Date | 22/07/2013 |