Individual
MR. LEENHAPONG NAVARAVONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
395 W COUGAR BLVD, PROVO, UT 84604-3311
(435) 357-4600
Mailing address
395 W COUGAR BLVD, PROVO, UT 84604-3311
(435) 357-4600
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
8237582-1205
UT
207RC0000X
Cardiovascular Disease Physician
8237582-1205
UT
207RC0000X
Cardiovascular Disease Physician
MD-42118
IA
207RC0001X
Clinical Cardiac Electrophysiology Physician
42118
IA
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
8237582-1205
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396937363
—
IA
01
—
P01437247
RR MEDICARE
IA
Enumeration date
08/14/2007
Last updated
06/21/2023
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