Provider Demographics
NPI:1003838186
Name:CHAN, SOKHOM RAPHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SOKHOM
Middle Name:RAPHAEL
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-4199
Mailing Address - Country:US
Mailing Address - Phone:304-623-3461
Mailing Address - Fax:304-623-7666
Practice Address - Street 1:VA MEDICAL CENTER, 1 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-4199
Practice Address - Country:US
Practice Address - Phone:304-623-3461
Practice Address - Fax:304-623-7666
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV191242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry