Provider Demographics
NPI:1487842597
Name:CHAUVAPUN, JOE POTCHANARD (MD)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:POTCHANARD
Last Name:CHAUVAPUN
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 1:327 E PALMDALE BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-7139
Mailing Address - Country:US
Mailing Address - Phone:310-953-5502
Mailing Address - Fax:
Practice Address - Street 1:327 E PALMDALE BLVD STE D
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-7139
Practice Address - Country:US
Practice Address - Phone:310-953-5502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1049252086S0129X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAM050376OtherGROUP
CABG654Medicare PIN