K. Jod Taywaditep, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

71006528 Issued in IL

Practice address

633 Emerson St
Evanston, IL 60208-0844

Phone

(847) 491-2151

NPI assigned

Sep 6, 2006

Last updated

Jul 7, 2009By the provider in NPPES

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

Other names 1

• Dr. Kittiwut J. Taywaditep Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1246924800000",
    "number": "1629171749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "633 EMERSON ST",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602080844",
            "telephone_number": "847-491-2151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 EMERSON ST",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602080844",
            "telephone_number": "847-491-2151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYWADITEP",
        "first_name": "K.",
        "middle_name": "JOD",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-06",
        "last_updated": "2009-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "71006528",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "01634395",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KITTIWUT",
            "last_name": "TAYWADITEP",
            "middle_name": "J.",
            "prefix": "DR.",
            "credential": "PH.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Nekesha Tart
• David Emil Taussig, LCSW, LMFT
• Andrianna Megan Taylor Kennedy
• Kara Cicely Taylor
• Susan Leigh Taylor, APN-CNP
• Judith Teibloom-Mishkin, RN, IBCLC
• Jeffrey C Teich, M.D.
• Karen Sue Teigiser, LCSW
• Abigail Ann Teisinger, BT
• Mary Ann Teister, CRNA

• Clinical Psychologist in Evanston, IL
• Providers in Evanston, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2009; 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.