Thaworn Rathananakintara, MD

Key facts

NPI

1154834075

Entity type

Individual (NPI type 1)

Primary specialty

Psychiatry Physician 2084P0800X

License

A30795 (CA)

Practice address

6838 W Sunset Blvd
Hollywood, CA 90028-7008

Phone

(323) 461-3161

NPI assigned

Nov 14, 2017

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Doctor of Medicine

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 14, 2017.

{
    "created_epoch": "1510617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510617600000",
    "number": "1154834075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11445 DONA DOLORES PL",
            "city": "STUDIO CITY",
            "state": "CA",
            "postal_code": "916044240",
            "telephone_number": "323-650-6276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6838 W SUNSET BLVD",
            "city": "HOLLYWOOD",
            "state": "CA",
            "postal_code": "900287008",
            "telephone_number": "323-461-3161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RATHANANAKINTARA",
        "first_name": "THAWORN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-11-14",
        "last_updated": "2017-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A30795",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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