Provider Demographics
NPI:1124681432
Name:TONGSUTHI, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:TONGSUTHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11623 ROSECRANS AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-3819
Mailing Address - Country:US
Mailing Address - Phone:562-868-8216
Mailing Address - Fax:562-406-1031
Practice Address - Street 1:11623 ROSECRANS AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3819
Practice Address - Country:US
Practice Address - Phone:562-868-8216
Practice Address - Fax:562-406-1031
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist