Individual
ISDA MAGSOMBOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
124 CHIPPEWA CT, GIRARD, OH 44420-3608
(330) 507-8962
Mailing address
124 CHIPPEWA CT, GIRARD, OH 44420-3608
(330) 507-8962
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
05/08/2026
Last updated
05/08/2026
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