Provider Demographics
NPI:1790997427
Name:PUANGSUVAN, SOMCHIN NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:SOMCHIN
Middle Name:NICHOLAS
Last Name:PUANGSUVAN
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 1:400 E PIONEER
Mailing Address - Street 2:STE. 101
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3255
Mailing Address - Country:US
Mailing Address - Phone:312-952-9684
Mailing Address - Fax:
Practice Address - Street 1:400 E PIONEER
Practice Address - Street 2:STE. 101
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3255
Practice Address - Country:US
Practice Address - Phone:312-952-9684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 60373294207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology