Healthcare Provider Details

I. General information

NPI: 1932255528
Provider Name (Legal Business Name): NARIN WONGNGAMNIT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9135 RIDGELINE BLVD STE 160
HIGHLANDS RANCH CO
80129-2395
US

IV. Provider business mailing address

4860 Y ST SUITE 3020
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 888-374-5066
  • Fax:
Mailing address:
  • Phone: 916-734-6688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberA113421
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number46059
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: