Provider Demographics
NPI:1700565033
Name:HIRUNNAKUL, KANJANAPORN
Entity type:Individual
Prefix:
First Name:KANJANAPORN
Middle Name:
Last Name:HIRUNNAKUL
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 1:8162 BROADLEAF AVE
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-5404
Mailing Address - Country:US
Mailing Address - Phone:818-922-4996
Mailing Address - Fax:
Practice Address - Street 1:8162 BROADLEAF AVE
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-5404
Practice Address - Country:US
Practice Address - Phone:818-922-4996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist