Provider Demographics
NPI:1386287126
Name:MINGPATUMKIJ, RUNGRADITH (LAC)
Entity type:Individual
Prefix:
First Name:RUNGRADITH
Middle Name:
Last Name:MINGPATUMKIJ
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 BARROW ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-6321
Mailing Address - Country:US
Mailing Address - Phone:917-831-2414
Mailing Address - Fax:
Practice Address - Street 1:141 BARROW ST APT 2A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-6321
Practice Address - Country:US
Practice Address - Phone:917-831-2414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006328171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist