Provider Demographics
NPI:1700576873
Name:WANNAPHUT, CHALOTHORN (MD)
Entity Type:Individual
Prefix:MISS
First Name:CHALOTHORN
Middle Name:
Last Name:WANNAPHUT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1356 LUSITANA STREET, UNIVERSITY OF HAWAII INTERNAL MED
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-586-2890
Mailing Address - Fax:808-586-2947
Practice Address - Street 1:1356 LUSITANA STREET, UNIVERSITY OF HAWAII INTERNAL MED
Practice Address - Street 2:7TH FLOOR
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-586-2890
Practice Address - Fax:808-586-2947
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program