Chanavuth Kanitsoraphan, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036159623 Issued in IL

Practice address

1356 Lusitana St Ste 510
Honolulu, HI 96813-2409

Phone

(808) 462-2776

NPI assigned

Jun 13, 2018

Last updated

Jun 13, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749772800000",
    "number": "1205329216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1356 LUSITANA ST STE 510",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968132409",
            "telephone_number": "808-462-2776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1356 LUSITANA ST STE 510",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968132409",
            "telephone_number": "808-462-2776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANITSORAPHAN",
        "first_name": "CHANAVUTH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-13",
        "last_updated": "2025-06-13",
        "certification_date": "2025-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "HI",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036159623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hyewon Kang
• Jin Wook Kang, PHARM D
• Mark Kang, M.D.
• Raymond Y Kang, MD
• Ricky Kang
• Brian Masato Kanno, LCSW
• Gerald M Kanno, RPH
• Loriann M Kanno
• Kanoelani Holomalia Behavior Analysis LLC
• Tatchaya Kanthajan, M.D.

• Internal Medicine Physician in Honolulu, HI
• Providers in Honolulu, HI by specialty
• Internal Medicine Physician in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.