Provider Demographics
NPI:1922240639
Name:PIYASKULKAEW, CHATCHAWAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHATCHAWAN
Middle Name:
Last Name:PIYASKULKAEW
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 1:16233 SYLVESTER RD SW STE 260
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3044
Mailing Address - Country:US
Mailing Address - Phone:206-835-7400
Mailing Address - Fax:253-274-7991
Practice Address - Street 1:16233 SYLVESTER RD SW STE 260
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3044
Practice Address - Country:US
Practice Address - Phone:206-835-7400
Practice Address - Fax:253-274-7991
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-42396207R00000X, 207RC0000X, 207RI0011X
WAMD60733496207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2076466Medicaid