Active NPI
Kittinun Klubdee
- Massage Therapist
- Glendale, CA
National Provider Identifier
1285364968
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 77799
- Practice address
- 1606 Rock Glen Ave Apt 8
Glendale, CA 91205-2075 - Phone
- (307) 797-1323
- NPI assigned
- Jun 15, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | 01190115 | CA | |
| Massage Therapist | 225700000X | 77799 | CA | Primary |
Addresses
Primary practice location
1606 Rock Glen Ave Apt 8
Glendale, CA 91205-2075
Mailing address
1606 Rock Glen Ave Apt 8
Glendale, CA 91205-2075
Phone (307) 797-1323
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
| License | State | Type | Specialty |
|---|---|---|---|
| 77799 | CA | MD | Massage Therapist |
| 01190115 | CA | MD | Nurse's Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655251200000",
"number": "1285364968",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1606 ROCK GLEN AVE APT 8",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912052075",
"telephone_number": "307-797-1323"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1606 ROCK GLEN AVE APT 8",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912052075",
"telephone_number": "307-797-1323"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLUBDEE",
"first_name": "KITTINUN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-06-15",
"last_updated": "2022-06-15",
"certification_date": "2022-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": "CA",
"license": "01190115",
"primary": false
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "77799",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 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.