Provider Demographics
NPI:1467281675
Name:PREEPREM, CHINDAWAN
Entity type:Individual
Prefix:
First Name:CHINDAWAN
Middle Name:
Last Name:PREEPREM
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 1:4949 PRINTERS WAY APT 362
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-3637
Mailing Address - Country:US
Mailing Address - Phone:469-955-2858
Mailing Address - Fax:
Practice Address - Street 1:2772 STONEBROOK PARKWAY
Practice Address - Street 2:SUITE 700 UNIT 115
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:469-955-2858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT138359225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist