Provider Demographics
NPI:1518306570
Name:CHAWENGSUB, YUTTANA (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:YUTTANA
Middle Name:
Last Name:CHAWENGSUB
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 SW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-2489
Mailing Address - Country:US
Mailing Address - Phone:785-295-8000
Mailing Address - Fax:785-295-5543
Practice Address - Street 1:601 DR MARTIN LUTHER KING JR AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3619
Practice Address - Country:US
Practice Address - Phone:505-727-8360
Practice Address - Fax:505-727-8768
Is Sole Proprietor?:No
Enumeration Date:2013-06-22
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125063902207R00000X
WAMD61203457207R00000X
KS04-40350207R00000X
NMMD2022-1256207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM93133201Medicaid
IL125063902OtherUPIN
WA2186267Medicaid