Provider Demographics
NPI:1780663658
Name:CHINAKARN, LATTEE W (MD)
Entity Type:Individual
Prefix:DR
First Name:LATTEE
Middle Name:W
Last Name:CHINAKARN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1524 SUNSET BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-1380
Mailing Address - Country:US
Mailing Address - Phone:740-282-9780
Mailing Address - Fax:740-282-9750
Practice Address - Street 1:1524 SUNSET BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-1380
Practice Address - Country:US
Practice Address - Phone:740-282-9780
Practice Address - Fax:740-282-9750
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35048710C208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000132280OtherANTHEM BLUE CROSS
WA000089262OtherMOUNTAIN STATE BLUE CROSS
OH0559284Medicaid
OHF93575Medicare UPIN