TANYAPORN K KAENKUMCHORN - Medical Doctor License in Illinois | # 125067368

TANYAPORN K KAENKUMCHORN

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125067368

License Status

EXPIRED

Business

N

First Name

TANYAPORN

Middle

K

Last Name

KAENKUMCHORN

Business Name

TANYAPORN K KAENKUMCHORN

Original Issue Date

07/01/2015

Effective Date

07/01/2015

Expiration Date

06/30/2018

City

CHICAGO

State

IL

Zip

60612

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

N

LastModifiedDate

10/25/2018