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General NPI Number Information
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NPI Number | 1972679611
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Entity Type | Individual
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Provider Name | CHIN THAPVONGSE MD
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Gender | Male
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1269 GRAND CONCOURSE
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City | BRONX
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State | NY
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Zip | 10452
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Country | US
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Telephone | 718-293-3424
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Fax | 718-293-3424
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Provider Business Mailing Address
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Address Line | 28 BIRCHDALE LANE
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City | PORT WASHINGTON
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State | NY
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Zip | 10050-4502
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Country | US
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Telephone | 516-627-2505
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 133396
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License Number State | NY
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