Provider Demographics
NPI:1245548700
Name:EUNGDAMRONG, NARAT JOHN (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:NARAT
Middle Name:JOHN
Last Name:EUNGDAMRONG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 VIA DE LA VALLE STE 200
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-1992
Mailing Address - Country:US
Mailing Address - Phone:858-309-3160
Mailing Address - Fax:
Practice Address - Street 1:2600 VIA DE LA VALLE STE 200
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-1992
Practice Address - Country:US
Practice Address - Phone:858-309-3160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270019207N00000X
CAA147593207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04536Medicare UPIN
NYG400178696Medicare UPIN