Individual
CHAIVAT PHUVADAKORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
351 E TEMPLE ST, MAIL CODE LAACC HOME BASED PRIMARY CARE A127A, LOS ANGELES, CA 90012-3328
(213) 253-5018
(213) 253-5018
Mailing address
1322 E MAPLE ST, GLENDALE, CA 91205-2607
(424) 236-2767
(213) 253-5017
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A122504
CA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
122504
CA
Other
Enumeration date
01/25/2012
Last updated
05/08/2024
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