Individual
EKKAPHOT PHANTHONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1790 ELLIS ST APT 24, CONCORD, CA 94520-2747
(443) 236-6919
Mailing address
1790 ELLIS ST APT 24, CONCORD, CA 94520-2747
(443) 236-6919
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
80047
CA
Other
Enumeration date
02/27/2023
Last updated
02/27/2023
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