Organization
VASANA CHEANVECHAI MD LTD
Active
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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