Provider Demographics
NPI:1205176054
Name:RUNGPRAI, CHAMNANNI
Entity type:Individual
Prefix:DR
First Name:CHAMNANNI
Middle Name:
Last Name:RUNGPRAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 OAKCREST ST APT 5
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-3418
Mailing Address - Country:US
Mailing Address - Phone:304-719-8606
Mailing Address - Fax:
Practice Address - Street 1:815 OAKCREST ST APT 5
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-3418
Practice Address - Country:US
Practice Address - Phone:304-719-8606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAT1130390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program