Healthcare Provider Details

I. General information

NPI: 1801046867
Provider Name (Legal Business Name): CHAIYAPORN BOONCHALERMVICHIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11480 BROOKSHIRE AVE SUITE 309
DOWNEY CA
90241-5018
US

IV. Provider business mailing address

18000 STUDEBAKER RD STE 800
CERRITOS CA
90703-2671
US

V. Phone/Fax

Practice location:
  • Phone: 562-869-1201
  • Fax: 562-869-1281
Mailing address:
  • Phone: 562-735-3226
  • Fax: 562-869-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number01098101A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number01098101A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number2008014384
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number01098101A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01098101A
License Number StateIN
# 6
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA112439
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: