Basic Information
Provider Information | |||||||||
NPI: | 1750376034 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NARAWONG | ||||||||
FirstName: | DUANGCHAI | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1200 PLEASANT ST | ||||||||
Address2: | SOUTH 2 ROOM 236 | ||||||||
City: | DES MOINES | ||||||||
State: | IA | ||||||||
PostalCode: | 503091406 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5152416228 | ||||||||
FaxNumber: | 5152418685 | ||||||||
Practice Location | |||||||||
Address1: | 1215 PLEASANT ST STE 116 | ||||||||
Address2: |   | ||||||||
City: | DES MOINES | ||||||||
State: | IA | ||||||||
PostalCode: | 503091409 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5152416544 | ||||||||
FaxNumber: | 5152416533 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/13/2005 | ||||||||
LastUpdateDate: | 11/15/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 26968 | IA | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 2084N0400X | 26968 | IA | Y |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
ID | Type | State | Issuer | Description | 1750376034 | 05 | IA |   | MEDICAID | 1522639 | 05 | TN |   | MEDICAID | 168773500 | 05 | MN |   | MEDICAID | 201930120 | 05 | MO |   | MEDICAID |