Provider Demographics
NPI:1174387054
Name:JUNTAVEE, VONGTAWAN (MD)
Entity type:Individual
Prefix:
First Name:VONGTAWAN
Middle Name:
Last Name:JUNTAVEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499/100 RAJA CITY MITTRAPHAP RD T.SILA A.MUEANG
Mailing Address - Street 2:
Mailing Address - City:KHON KAEN
Mailing Address - State:KHON KAEN
Mailing Address - Zip Code:40000
Mailing Address - Country:TH
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 E UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2829
Practice Address - Country:US
Practice Address - Phone:410-554-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program