Individual
KRITTUSSAPON KHEAWBUA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
14030 CHADRON AVE APT 235, HAWTHORNE, CA 90250-8247
(310) 456-4999
Mailing address
14030 CHADRON AVE APT 235, HAWTHORNE, CA 90250-8247
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
85742
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
54132
—
CA
Enumeration date
03/14/2022
Last updated
03/14/2022
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