Provider Demographics
NPI:1518306570
Name:CHAWENGSUB, YUTTANA (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:YUTTANA
Middle Name:
Last Name:CHAWENGSUB
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MERCY DR
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-3128
Mailing Address - Country:US
Mailing Address - Phone:855-524-4001
Mailing Address - Fax:712-325-2499
Practice Address - Street 1:800 MERCY DR
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-3128
Practice Address - Country:US
Practice Address - Phone:855-524-4001
Practice Address - Fax:712-325-2499
Is Sole Proprietor?:No
Enumeration Date:2013-06-22
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125063902207R00000X
WAMD61203457207R00000X
KS04-40350207R00000X
NMMD2022-1256207R00000X
NECP1338208M00000X
IAMD-43157208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL125063902OtherUPIN
WA2186267Medicaid
NM93133201Medicaid