Krittussapon Kheawbua

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

85742 Issued in CA

Practice address

14030 Chadron Ave Apt 235
Hawthorne, CA 90250-8247

Phone

(310) 456-4999

NPI assigned

Mar 14, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1647216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647216000000",
    "number": "1194473710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14030 CHADRON AVE APT 235",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902508247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14030 CHADRON AVE APT 235",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902508247",
            "telephone_number": "310-456-4999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHEAWBUA",
        "first_name": "KRITTUSSAPON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-03-14",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "CA",
            "license": "85742",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54132",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "krittussapon@gmail.com",
            "affiliation": "N",
            "address_1": "14030 Chadron Ave Apt 235",
            "city": "Hawthorne",
            "state": "CA",
            "country_code": "US",
            "postal_code": "902508247",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "krittussapon@gmail.com",
            "affiliation": "N",
            "address_1": "14030 Chadron Ave Apt 235",
            "city": "Hawthorne",
            "state": "CA",
            "country_code": "US",
            "postal_code": "902508247",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• James Walter Kelsey, OD
• Mara Kenyon, MS, OTR/L
• Khalid B. Khan M.D., Inc
• Khalid B Khan, M.D.
• Azadeh Khatami, D.D.S.
• Nasrin Khorram, DDS
• Alison Kielty, MSOT
• Whitley Killian
• Eunice Kim, PPS
• Harper Kim

• Massage Therapist in Hawthorne, CA
• Providers in Hawthorne, CA by specialty
• Massage Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2022; 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.