Provider Demographics
NPI:1588738967
Name:PINYAVAT, NAKORN (MD)
Entity type:Individual
Prefix:
First Name:NAKORN
Middle Name:
Last Name:PINYAVAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2230
Mailing Address - Country:US
Mailing Address - Phone:718-221-1111
Mailing Address - Fax:718-221-0714
Practice Address - Street 1:700 UTICA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2230
Practice Address - Country:US
Practice Address - Phone:718-221-1111
Practice Address - Fax:718-221-0714
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133744208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00430662Medicaid
NY11D281Medicare ID - Type Unspecified
NYB00136Medicare UPIN