Basic Information
| Provider Information | |||||||||
| NPI: | 1598706343 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THIENPRASIT | ||||||||
| FirstName: | DARIT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 969090 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921969090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584950971 | ||||||||
| FaxNumber: | 8584950991 | ||||||||
| Practice Location | |||||||||
| Address1: | 3630 E IMPERIAL HWY | ||||||||
| Address2: | |||||||||
| City: | LYNWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902622636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109007420 | ||||||||
| FaxNumber: | 3106036586 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A36642 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 00A366420 | 05 | CA | MEDICAID | A36642 | 01 | CA | MEDICAL LICENSE | OTHER |