| NPI | 1154315828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PUMIPAK TANTAMJARIK Physician 714-641-1610 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A71362) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A31595) |
| 208D00000X General Practice (Licence: CA A31442) | |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2023-02-23 |