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:
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Health care specialties

SpecialtyCodeLicense #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 15 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639124530 NPPES
Rhode Island MEDICAID CP46587

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