Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 017469 | CT |
NPI | 1134284615 |
---|---|
Provider Name | Theerayut Chumnanvech |
First Address | Norwalk, CT 06850 |
Second Address | Norwalk, CT 06850 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1174697 | (05) | CT |
B38632 | (02) |