Individual
KANOKPORN MONGKOLRATTANOTHAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4650 W SUNSET BLVD, MAILSTOP # 51, LOS ANGELES, CA 90027-6062
(323) 361-8736
(323) 361-1183
Mailing address
4650 W SUNSET BLVD, MAILSTOP # 51, LOS ANGELES, CA 90027-6062
(323) 361-8736
(323) 361-1183
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036112843
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036112843
—
IL
01
—
07215036
BCBS
IL
Enumeration date
03/15/2006
Last updated
05/07/2024
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