Healthcare Provider Details

I. General information

NPI: 1467651331
Provider Name (Legal Business Name): VASANA CHEANVECHAI MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S RANCHO DR SUITE F 38
LAS VEGAS NV
89106-4828
US

IV. Provider business mailing address

840 S RANCHO DR SUITE 4321
LAS VEGAS NV
89106-3837
US

V. Phone/Fax

Practice location:
  • Phone: 702-258-1173
  • Fax: 702-258-1293
Mailing address:
  • Phone: 702-258-1173
  • Fax: 702-258-1293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number11662
License Number StateNV

VIII. Authorized Official

Name: DR. VASANA CHEANVECHAI
Title or Position: PRESIDENT
Credential: MD
Phone: 702-258-1173