Individual
THONGDANG BANCHUIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
280 VIRGINIA AVE NE, SUITE 102, NORTON, VA 24273-1538
(276) 679-0818
(276) 679-0817
Mailing address
999 EXECUTIVE PARK BLVD, SUITE 201, KINGSPORT, TN 37660-4632
(423) 224-3250
(423) 224-3258
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101029458
VA
208D00000X
General Practice Physician
0101029458
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010041660
—
VA
Enumeration date
09/20/2006
Last updated
07/27/2012
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