Provider Demographics
NPI:1407888977
Name:CHATKUPT, SURACHAT (MD)
Entity Type:Individual
Prefix:DR
First Name:SURACHAT
Middle Name:
Last Name:CHATKUPT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:WAIMEA
Mailing Address - State:HI
Mailing Address - Zip Code:96796-0669
Mailing Address - Country:US
Mailing Address - Phone:808-338-8311
Mailing Address - Fax:808-338-0225
Practice Address - Street 1:4643B WAIMEA CANYON DRIVE
Practice Address - Street 2:
Practice Address - City:WAIMEA
Practice Address - State:HI
Practice Address - Zip Code:96796
Practice Address - Country:US
Practice Address - Phone:808-338-8311
Practice Address - Fax:808-338-0225
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-12678207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIC55175OtherKAISER
HI99-0262194OtherHMAA
HI503716OtherHMA
HI17402OtherUHA
HI546418OtherALOHACARE
HI54641801Medicaid
HI0000244715OtherHMSA
HI503716OtherHMA