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Organization

VASANA CHEANVECHAI MD LTD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. VASANA CHEANVECHAI MD (PRESIDENT)
(702) 258-1173
Entity
Organization

Contact information

Practice address
501 S RANCHO DR, SUITE F 38, LAS VEGAS, NV 89106-4828
(702) 258-1173
(702) 258-1293
Mailing address
840 S RANCHO DR, SUITE 4321, LAS VEGAS, NV 89106-3837
(702) 258-1173
(702) 258-1293

Taxonomy

Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
11662
NV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100508393
MEDICAID GROUP NUMBER
NV
01
101864
MEDICARE ID TYPE
NV
01
CC1844
ANTHEM BX BS
NV
Enumeration date
07/12/2007
Last updated
04/09/2012
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