Provider Demographics
NPI:1861939878
Name:JURAWANICHKUL, SAI (LAC)
Entity type:Individual
Prefix:MS
First Name:SAI
Middle Name:
Last Name:JURAWANICHKUL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2759 S NORFOLK ST
Mailing Address - Street 2:#311
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-5506
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2759 S NORFOLK ST
Practice Address - Street 2:#311
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-5506
Practice Address - Country:US
Practice Address - Phone:347-237-7160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-28
Last Update Date:2017-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25005904171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist