Provider Demographics
NPI:1528398682
Name:JUNGTRAKOOLCHAI, VASIN (MD)
Entity Type:Individual
Prefix:DR
First Name:VASIN
Middle Name:
Last Name:JUNGTRAKOOLCHAI
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 1:999 S MARINE CORPS DR
Mailing Address - Street 2:UNIT 702
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3415
Mailing Address - Country:US
Mailing Address - Phone:671-977-5964
Mailing Address - Fax:
Practice Address - Street 1:999 S MARINE CORPS DR
Practice Address - Street 2:UNIT 702
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3415
Practice Address - Country:US
Practice Address - Phone:671-977-5964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM-1691207R00000X, 207RG0300X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUH107516Medicare Oscar/Certification
GUH107378Medicare Oscar/Certification