| NPI | 1114364551 |
|---|---|
| Other Name | JASON KIANGSOONTRA |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: VA 0401415189) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MN R558) |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2018-12-08 |