Satja Issaranggoon NA Ayuthaya, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

50187 Issued in IA

Practice address

1223 S Gear Ave Ste 108
West Burlington, IA 52655-1685

Phone

(319) 768-5858

Fax

(319) 753-0893

NPI assigned

Jul 29, 2017

Last updated

Aug 10, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Satja Issaranggoon Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1501286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660089600000",
    "number": "1629592837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1223 S GEAR AVE STE 108",
            "city": "WEST BURLINGTON",
            "state": "IA",
            "postal_code": "526551685",
            "telephone_number": "319-768-5858",
            "fax_number": "319-753-0893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1223 S GEAR AVE STE 108",
            "city": "WEST BURLINGTON",
            "state": "IA",
            "postal_code": "526551685",
            "telephone_number": "319-768-5858",
            "fax_number": "319-753-0893"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1706 W Agency Rd",
            "address_purpose": "LOCATION",
            "city": "West Burlington",
            "state": "IA",
            "postal_code": "526551667",
            "country_code": "US",
            "telephone_number": "319-768-5858",
            "fax_number": "319-752-4653",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ISSARANGGOON NA AYUTHAYA",
        "first_name": "SATJA",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-29",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IA",
            "license": "50187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SATJA",
            "last_name": "ISSARANGGOON",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Pediatrics Physician in West Burlington, IA
• Providers in West Burlington, IA by specialty
• Pediatrics Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.