Provider Demographics
NPI:1487842597
Name:CHAUVAPUN, JOE POTCHANARD (MD)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:POTCHANARD
Last Name:CHAUVAPUN
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 1:15030 7TH ST
Mailing Address - Street 2:DEPARTMENT OF SURGERY
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-3811
Mailing Address - Country:US
Mailing Address - Phone:760-951-0065
Mailing Address - Fax:760-951-5382
Practice Address - Street 1:15030 7TH ST
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3811
Practice Address - Country:US
Practice Address - Phone:760-951-0065
Practice Address - Fax:760-951-5382
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104925207QA0401X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAM050376OtherGROUP
CABG654Medicare PIN