| Doctor Name: | DR. CHAIYOS KHONGKHATITHUM |
| NPI Number: | 1033377528 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 57012391 |
| Business Practice Address: | 5323 Harry Hines Blvd Ut Southwestern Medical Center, Div. Of Pediatric Neuro Dallas, TX - 753907201 |
| Business Phone Number: | 2144568242 |
| Business Fax Number: | |
| Mailing Address: | 12000 Fairhill Rd, Apt. G1 CLEVELAND |
| State: | OH |
| Postal Code: | 441201035 |
| Phone Number: | 2164663510 |
| Fax Number: | |
| NPI Enumeration Date: | 05/30/2008 |
| NPI Last Update Date: | 05/30/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | 57012391 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |