Provider Demographics
NPI:1326848490
Name:MINANOND, KANOKPORN
Entity type:Individual
Prefix:
First Name:KANOKPORN
Middle Name:
Last Name:MINANOND
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4923 N LEAVITT ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1308
Mailing Address - Country:US
Mailing Address - Phone:312-774-5240
Mailing Address - Fax:
Practice Address - Street 1:3036 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3539
Practice Address - Country:US
Practice Address - Phone:773-270-1703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist