Provider Demographics
NPI:1184063570
Name:CHIVANGKUL, CHONLADA (MD)
Entity type:Individual
Prefix:
First Name:CHONLADA
Middle Name:
Last Name:CHIVANGKUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 W 238TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-5915
Mailing Address - Country:US
Mailing Address - Phone:646-853-3747
Mailing Address - Fax:
Practice Address - Street 1:2888 LONG BEACH BLVD STE 235
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806
Practice Address - Country:US
Practice Address - Phone:562-424-4447
Practice Address - Fax:562-216-1785
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2019-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA138067207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology