Provider Demographics
NPI:1174697254
Name:KUNAKORN, THIRA (MD)
Entity type:Individual
Prefix:MR
First Name:THIRA
Middle Name:
Last Name:KUNAKORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:THIRAPAN
Other - Middle Name:
Other - Last Name:KUNAKORNSKUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1120 W LA PALMA AVE
Mailing Address - Street 2:#6
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2820
Mailing Address - Country:US
Mailing Address - Phone:714-776-6930
Mailing Address - Fax:714-776-3345
Practice Address - Street 1:1120 W LA PALMA AVE STE 6
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2820
Practice Address - Country:US
Practice Address - Phone:714-776-6930
Practice Address - Fax:714-776-3345
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29554207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
A29554OtherCALIFORNIA LICENSE
A29554OtherCALIFORNIA LICENSE
AK 9151286OtherDEA #