Provider Demographics
NPI:1902119035
Name:CHIMJUN, KANIDTHA
Entity Type:Individual
Prefix:MS
First Name:KANIDTHA
Middle Name:
Last Name:CHIMJUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WATER ST APT 14101
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-5293
Mailing Address - Country:US
Mailing Address - Phone:832-244-9250
Mailing Address - Fax:
Practice Address - Street 1:200 WATER ST APT 14101
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-5293
Practice Address - Country:US
Practice Address - Phone:832-244-9250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-18
Last Update Date:2010-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT100877225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist