| Doctor Name: | DR. KULTIDA SOONTARAPORNCHAI |
| NPI Number: | 1225242662 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | |
| Business Practice Address: | 10001 S Eastern Ave Suite 310 Henderson, NV - 890523907 |
| Business Phone Number: | 7025662400 |
| Business Fax Number: | 7024332477 |
| Mailing Address: | 10001 S Eastern Ave, Suite 310 HENDERSON |
| State: | NV |
| Postal Code: | 890523907 |
| Phone Number: | 7025662400 |
| Fax Number: | 7024332477 |
| NPI Enumeration Date: | 05/09/2007 |
| NPI Last Update Date: | 03/07/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| 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. |