Basic Information
| Provider Information | |||||||||
| NPI: | 1184826356 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TIENGBURANATARM | ||||||||
| FirstName: | KORSIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 S KUKUI ST # D1207 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968132328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6074372531 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 347 N KUAKINI ST # HPM-9 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968172336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085238461 | ||||||||
| FaxNumber: | 8085281897 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.