Provider Demographics
NPI:1629592837
Name:ISSARANGGOON NA AYUTHAYA, SATJA (MD)
Entity Type:Individual
Prefix:MR
First Name:SATJA
Middle Name:
Last Name:ISSARANGGOON NA AYUTHAYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SATJA
Other - Middle Name:
Other - Last Name:ISSARANGGOON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1223 S GEAR AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1685
Mailing Address - Country:US
Mailing Address - Phone:319-768-5858
Mailing Address - Fax:319-753-0893
Practice Address - Street 1:1223 S GEAR AVE STE 108
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1685
Practice Address - Country:US
Practice Address - Phone:319-768-5858
Practice Address - Fax:319-753-0893
Is Sole Proprietor?:No
Enumeration Date:2017-07-29
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA50187208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics