Khongruk Wongkittiroch, D.O.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

OS11792 Issued in FL

Practice address

2838 E Oakland Park Blvd
Ste 201
Fort Lauderdale, FL 33306-1814

Phone

(954) 564-0040

Fax

(954) 564-0048

NPI assigned

May 12, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Micrographic Dermatologic Surgery (MDS)Also: Dermatology

Education

Midwestern University, Chicago College of Osteopathic Med, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

South Florida Surgical Specialists LLCGroup PAC ID 5799881660, 91 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• South Florida Surgical Specialists LLC

  • Surgery Physician
  • Coral Springs, FL
  • NPI 1952409963
  Medicare reassignment Care Compare group NPD
• Feinstein Medical LLC

  • Dermatology Physician
  • Delray Beach, FL
  • NPI 1548416068
  Medicare reassignment NPD
• Skin and Cancer Associates

  • Dermatology Physician
  • Plantation, FL
  • NPI 1740737576
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418860800000",
    "number": "1205003068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2838 E OAKLAND PARK BLVD",
            "address_2": "STE 201",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333061814",
            "telephone_number": "954-564-0040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2838 E OAKLAND PARK BLVD",
            "address_2": "STE 201",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333061814",
            "telephone_number": "954-564-0040",
            "fax_number": "954-564-0048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONGKITTIROCH",
        "first_name": "KHONGRUK",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-12",
        "last_updated": "2014-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "OS11792",
            "primary": true
        },
        {
            "code": "207NI0002X",
            "taxonomy_group": "",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": "FL",
            "license": "OS11792",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "FL",
            "license": "OS11792",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "FL",
            "license": "OS11792",
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "FL",
            "license": "OS11792",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "FL",
            "license": "OS11792",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF FLORIDA",
            "identifier": "28528",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTI PLAN",
            "identifier": "261637814",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED",
            "identifier": "317129",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "261637814",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "6375863",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Women's Surgical Specialists PA
• Cynthia Wong
• Jackson Wong, M.D.
• Lily Wong, PHARM.D
• Richard HC Wong, PHARMD
• Kirsten Wonn, RD/LDN
• Kimberly Woo
• Eric J Wood, N.D., M.A.
• Sydney Wood, CRNA
• Tempes L Wood, APRN

• Dermatology Physician in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.