Individual
KASANU PATTHANADETTRAKUL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
15511 SHERMAN WAY APT 43, VAN NUYS, CA 91406-4156
(949) 524-2555
Mailing address
15511 SHERMAN WAY APT 43, VAN NUYS, CA 91406-4156
(949) 524-2555
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
243
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10431980
LA CARE
CA
Enumeration date
02/02/2022
Last updated
04/01/2024
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