Provider Demographics
NPI:1467651331
Name:VASANA CHEANVECHAI MD LTD
Entity Type:Organization
Organization Name:VASANA CHEANVECHAI MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VASANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEANVECHAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-258-1173
Mailing Address - Street 1:840 S RANCHO DR
Mailing Address - Street 2:SUITE 4321
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-3837
Mailing Address - Country:US
Mailing Address - Phone:702-258-1173
Mailing Address - Fax:702-258-1293
Practice Address - Street 1:501 S RANCHO DR
Practice Address - Street 2:SUITE F 38
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4828
Practice Address - Country:US
Practice Address - Phone:702-258-1173
Practice Address - Fax:702-258-1293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV116622086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV101864OtherMEDICARE ID TYPE
NV100508393MedicaidMEDICAID GROUP NUMBER
NVCC1844OtherANTHEM BX BS
NVCC1844OtherANTHEM BX BS