Provider Demographics
NPI:1447357694
Name:BANCHUIN, THONGDANG (MD)
Entity type:Individual
Prefix:
First Name:THONGDANG
Middle Name:
Last Name:BANCHUIN
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 1:999 EXECUTIVE PARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4632
Mailing Address - Country:US
Mailing Address - Phone:423-224-3250
Mailing Address - Fax:423-224-3258
Practice Address - Street 1:280 VIRGINIA AVE NE
Practice Address - Street 2:SUITE 102
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1538
Practice Address - Country:US
Practice Address - Phone:276-679-0818
Practice Address - Fax:276-679-0817
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101029458208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010041660Medicaid
VA020001494Medicare PIN
VAV V2331BMedicare PIN
VAV V2331AMedicare PIN