Basic Information
| Provider Information | |||||||||
| NPI: | 1720413503 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUMONSAVADIT | ||||||||
| FirstName: | SHAWN | ||||||||
| MiddleName: | TIRACHAI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10605 BALBOA BLVD. | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | GRANADA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188322400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10605 BALBOA BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | GRANADA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913446367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188322400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2013 | ||||||||
| LastUpdateDate: | 05/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCSW80818 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.