Individual
EDWARD PAKORN TANGCHITNOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1135 S SUNSET AVE STE 102, WEST COVINA, CA 91790-3937
(626) 338-5377
Mailing address
1135 S SUNSET AVE STE 102, WEST COVINA, CA 91790-3937
(626) 338-5377
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
A110608
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063842649
—
CA
01
—
1396996294
PTAN
CA
01
—
CB208996
PTAN
CA
Enumeration date
10/09/2008
Last updated
06/29/2016
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