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NPI Code Detail

MEDICARE: BENJAMIN VACHIRAKORNTONG DO

MEDICARE: BENJAMIN VACHIRAKORNTONG DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1306784194
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN VACHIRAKORNTONG DO
Provider Business Mailing Address
First Line : 1701 W CHARLESTON BLVD STE 230
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2312
Country : US
Telephone Number : 702-671-2358
Fax Number :
Provider Business Practice Location Address
First Line : 1701 W CHARLESTON BLVD STE 230
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2312
Country : US
Telephone Number : 702-671-2358
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2026
Last Update Date : 03/23/2026

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