Provider Demographics
NPI:1699882415
Name:NADEMANEE, KOONLAWEE (MD)
Entity type:Individual
Prefix:DR
First Name:KOONLAWEE
Middle Name:
Last Name:NADEMANEE
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:P.O. BOX 33679
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-0679
Mailing Address - Country:US
Mailing Address - Phone:310-672-9999
Mailing Address - Fax:310-861-0540
Practice Address - Street 1:1700 CESAR E. CHAVEZ AVENUE
Practice Address - Street 2:SUITE 2700
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2434
Practice Address - Country:US
Practice Address - Phone:310-672-9999
Practice Address - Fax:310-861-0540
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32891207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0090210Medicaid
A84402Medicare UPIN
CAGR0090210Medicaid
CAA84402Medicare UPIN