Provider Demographics
NPI:1477651933
Name:DUANGJAK, VICHAIE (MD)
Entity Type:Individual
Prefix:DR
First Name:VICHAIE
Middle Name:
Last Name:DUANGJAK
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 1:12475 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9028
Mailing Address - Country:US
Mailing Address - Phone:440-286-6633
Mailing Address - Fax:440-286-1118
Practice Address - Street 1:12475 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-9028
Practice Address - Country:US
Practice Address - Phone:440-286-6633
Practice Address - Fax:440-286-1118
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35034212174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist