Basic Information
| Provider Information | |||||||||
| NPI: | 1407888977 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHATKUPT | ||||||||
| FirstName: | SURACHAT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 669 | ||||||||
| Address2: | |||||||||
| City: | WAIMEA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967960669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083388311 | ||||||||
| FaxNumber: | 8083380225 | ||||||||
| Practice Location | |||||||||
| Address1: | 4643B WAIMEA CANYON DRIVE | ||||||||
| Address2: | |||||||||
| City: | WAIMEA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083388311 | ||||||||
| FaxNumber: | 8083380225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 03/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD-12678 | HI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | C55175 | 01 | HI | KAISER | OTHER | 99-0262194 | 01 | HI | HMAA | OTHER | 503716 | 01 | HI | HMA | OTHER | 17402 | 01 | HI | UHA | OTHER | 546418 | 01 | HI | ALOHACARE | OTHER | 54641801 | 05 | HI | MEDICAID | 0000244715 | 01 | HI | HMSA | OTHER |