| NPI | 1730373101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUWAPANG PATTUMMADITH President 909-592-2816 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A32823) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: CA A32823) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA A32823) | |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2008-03-27 |