Individual
DR. PONGCHANOK PAKDEESUPAPOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6355 S BUFFALO DR FL 3, LAS VEGAS, NV 89113-2133
(702) 952-9171
(702) 952-9170
Mailing address
6355 S BUFFALO DR FL 3, LAS VEGAS, NV 89113-2133
(702) 216-3346
(702) 671-6883
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
17040
NV
207R00000X
Internal Medicine Physician
A140027
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679992325
—
NV
01
—
PENDING
MEDICARE PIN
NV
Enumeration date
04/09/2014
Last updated
11/01/2022
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