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General NPI Number Information
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NPI Number | 1841565611
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Entity Type | Individual
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Provider Name | EKKAWIT CHANCHORN M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 2650 N TENAYA WAY STE 360
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City | LAS VEGAS
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State | NV
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Zip | 89128-1102
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Country | US
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Telephone | 702-240-0088
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Fax | 702-240-3049
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Provider Business Mailing Address
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Address Line | 6355 S BUFFALO DR FL 3
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City | LAS VEGAS
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State | NV
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Zip | 89113-2133
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Country | US
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Telephone | 702-216-3346
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Fax | 702-671-6883
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A154540
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 036138141
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 23869
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License Number State | NV
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