Phornphutkul, Chanika
Phornphutkul, Chanika is an individual health care provider with primary practice located at 593 Eddy St , Providence RI 02903-4923. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatric Endocrinology, Allopathic & Osteopathic Physicians / Clinical Biochemical Genetics. Allopathic & Osteopathic Physicians / Clinical Biochemical Genetics is her primary health care specialty. Phornphutkul, Chanika can be contacted via phone (401) 444-8361.Contact Information
Primary practice address
593 Eddy St
Providence RI 02903-4923
Phone: (401) 444-8361
Fax: (401) 444-3288
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatric Endocrinology | 2080P0205X | 10121 | Rhode Island |
| Allopathic & Osteopathic Physicians / Clinical Biochemical Genetics | 207SG0202X | MD10121 | Rhode Island |
Profile Details
| NPI number | 1639124530 |
|---|---|
| LBN Legal business name | Phornphutkul, Chanika |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 23rd, 2006 |
| Last updated | Dec 21st, 2011 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639124530 | NPPES |
| Rhode Island | MEDICAID | CP46587 |
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