Provider Demographics
NPI:1144016601
Name:TIYARATTANACHAI, THODSAWIT
Entity type:Individual
Prefix:
First Name:THODSAWIT
Middle Name:
Last Name:TIYARATTANACHAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 PHETKASEM 88/1, PHETKASEM RD.
Mailing Address - Street 2:
Mailing Address - City:BANGKAE
Mailing Address - State:BANGKOK
Mailing Address - Zip Code:10160
Mailing Address - Country:TH
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-789-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-19
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program