Individual provider · NPI-1

Kevin Chivacharoen

Physician Assistant · Westminster, CA

NPI number1801442694
StatusActive
Last updated in NPPESMay 15, 2023

Details

NPI
1801442694
Entity type
Individual (NPI-1)
Name
Kevin Chivacharoen
Sex
Male
Sole proprietor
No
Enumeration date
Aug 16, 2019
Certification date
May 15, 2023
Last updated
May 15, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363A00000X Physician AssistantPA57086CAYes

Practice location

14371 Riverton St
Westminster, CA 92683-4692

Phone 714-728-7428

Mailing address

14371 Riverton St
Westminster, CA 92683-4692

Phone 714-728-2851

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