Provider Demographics
NPI:1154033363
Name:YOMMA, KRITTIYANEE
Entity type:Individual
Prefix:MS
First Name:KRITTIYANEE
Middle Name:
Last Name:YOMMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 W 27TH ST RM 401
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6929
Mailing Address - Country:US
Mailing Address - Phone:929-924-5565
Mailing Address - Fax:
Practice Address - Street 1:28 W 27TH ST RM 401
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6929
Practice Address - Country:US
Practice Address - Phone:929-924-5565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10729225700000X
NY029414-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty