Provider Demographics
NPI:1235760455
Name:CHOKJARUNATE, PONGKARN
Entity Type:Individual
Prefix:
First Name:PONGKARN
Middle Name:
Last Name:CHOKJARUNATE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9625 S BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445-8929
Mailing Address - Country:US
Mailing Address - Phone:407-405-0720
Mailing Address - Fax:
Practice Address - Street 1:1250 LAMOILLE HWY STE 103
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-4397
Practice Address - Country:US
Practice Address - Phone:775-777-1292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician