Provider Demographics
NPI:1699871467
Name:JITPAKDEE, SASITHORN RATANAPRAKARN (MD)
Entity type:Individual
Prefix:DR
First Name:SASITHORN
Middle Name:RATANAPRAKARN
Last Name:JITPAKDEE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2509 W MCFADDEN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-2747
Mailing Address - Country:US
Mailing Address - Phone:714-542-4724
Mailing Address - Fax:714-542-4723
Practice Address - Street 1:2509 W MCFADDEN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-2747
Practice Address - Country:US
Practice Address - Phone:714-542-4724
Practice Address - Fax:714-542-4723
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2010-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA38940207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A389400Medicaid
CA00A389400Medicaid
CAI50110Medicare UPIN