Provider Demographics
NPI:1194808576
Name:BOONYAKIAT, PORNPIMON (MD)
Entity type:Individual
Prefix:DR
First Name:PORNPIMON
Middle Name:
Last Name:BOONYAKIAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 S MARYLAND PKWY
Mailing Address - Street 2:STE 270
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2218
Mailing Address - Country:US
Mailing Address - Phone:702-369-6161
Mailing Address - Fax:702-369-3361
Practice Address - Street 1:3006 S MARYLAND PKWY
Practice Address - Street 2:STE 270
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2218
Practice Address - Country:US
Practice Address - Phone:702-369-6161
Practice Address - Fax:702-369-3361
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5805208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics