NPIMap

Individual provider Active NPI

Nichkamon Udomlarp

  • Massage Therapist
  • Edina, MN
National Provider Identifier
1194015396
Registry record updated Apr 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
708013939 Issued in MN
Practice address
1675 Southdale Ctr
1675 Southdale Center
Edina, MN 55435-7015
Phone
(952) 922-3600
Fax
(952) 922-3600
NPI assigned
Apr 9, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X 708013939 MN Primary

Addresses

Primary practice location

1675 Southdale Ctr
1675 Southdale Center
Edina, MN 55435-7015

Mailing address

1675 Southdale Ctr
1675 Southdale Center
Edina, MN 55435-7015
Phone (952) 922-3600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
708013939MNMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Zen Chiropractic Incoporated Past Accepting new patients
Ocean Waves Massage & 02 Lounge Massage Therapist Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1302307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302307200000",
    "number": "1194015396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1675 SOUTHDALE CTR",
            "address_2": "1675 SOUTHDALE CENTER",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554357015",
            "telephone_number": "952-922-3600",
            "fax_number": "952-922-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1675 SOUTHDALE CTR",
            "address_2": "1675 SOUTHDALE CENTER",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554357015",
            "telephone_number": "952-922-3600",
            "fax_number": "952-922-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UDOMLARP",
        "first_name": "NICHKAMON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-09",
        "last_updated": "2011-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "MN",
            "license": "708013939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.