1962513952 NPI number — SUCHINT WATHANACHAROEN MD

Table of content: SUCHINT WATHANACHAROEN MD (NPI 1962513952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962513952 NPI number — SUCHINT WATHANACHAROEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATHANACHAROEN
Provider First Name:
SUCHINT
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962513952
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2330 SHAWNEE MISSION PKWY
Provider Second Line Business Mailing Address:
MEDICAL ADMINISTRATIVE SERVICES OF KU MED. STE 312
Provider Business Mailing Address City Name:
WESTWOOD
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66205-2005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-588-9000
Provider Business Mailing Address Fax Number:
913-588-9822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3901 RAINBOW BLVD
Provider Second Line Business Practice Location Address:
PROFESSIONAL SERVICES OF KU HOSPITAL
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66160-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-588-7743
Provider Business Practice Location Address Fax Number:
913-588-9786
Provider Enumeration Date:
08/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  04-17385 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: 04-17385 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X , with the licence number: 04-17385 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03077025 . This is a "BCBS PSKU PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4002033 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 513021 . This is a "PSKU FIRSTGUARD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10001081901 . This is a "CHP PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".