Individual
DR. CHAMNAHN KONGTAHWORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12950 WOODLANDS PKWY, CLIVE, IA 50325-8748
(515) 225-2369
Mailing address
12950 WOODLANDS PKWY, CLIVE, IA 50325-8748
(515) 225-2369
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
20052
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20052
MEDICAL LICENSE
IA
Enumeration date
12/20/2011
Last updated
12/20/2011
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