Individual
CHULACHAK JON SUKACHEVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7101 NE 137TH AVE, VANCOUVER, WA 98682-4933
(800) 813-2000
Mailing address
500 NE MULTNOMAH ST STE 100, PORTLAND, OR 97232-2031
(800) 813-2000
(855) 524-5255
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
D0054571
MD
207Q00000X
Family Medicine Physician
Primary
MD 60173771
WA
207Q00000X
Family Medicine Physician
MD15286
OR
Other
Enumeration date
07/29/2005
Last updated
05/21/2025
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