Provider Demographics
NPI:1861370868
Name:CHANTANARUNG, YUTT
Entity type:Individual
Prefix:MR
First Name:YUTT
Middle Name:
Last Name:CHANTANARUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 E CAROB DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-8485
Mailing Address - Country:US
Mailing Address - Phone:480-495-6478
Mailing Address - Fax:
Practice Address - Street 1:2521 E CAROB DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-8485
Practice Address - Country:US
Practice Address - Phone:480-495-6478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN214059163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine