Healthcare Provider Details

I. General information

NPI: 1518956804
Provider Name (Legal Business Name): CHANWIT ROONGSRITONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2385 E PRATER WAY STE 302
SPARKS NV
89434-9638
US

IV. Provider business mailing address

2385 E PRATER WAY STE 302
SPARKS NV
89434-9638
US

V. Phone/Fax

Practice location:
  • Phone: 775-356-4514
  • Fax: 775-356-4991
Mailing address:
  • Phone: 775-356-4514
  • Fax: 775-356-4991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number12355
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberJ0232
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberJ0232
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number12355
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: