KANYA VANADURONGVAN, M.D. — NPI 1760446603 (Licensed & Credentialed Allopathic & Osteopathic Physicians

CMS-1500 Box 24J / 33a • NPI

1760446603

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

208D00000X (CMS 01)

Licensed & Credentialed Allopathic & Osteopathic Physicians — General Practice

Box 32 Service Location & ZIP+4

803 E MILBANK AVE, MILBANK, SD, 57252-1413

✓ 9-Digit EDI 837 ZIP+4 (57252-1413)

Practice Phone & Referral Fax

(605) 432-4587

Fax: (605) 432-4580

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1760446603 (KANYA VANADURONGVAN, M.D.) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1760446603` (NPI-1 Individual Practitioner)
Provider / Legal Name	KANYA VANADURONGVAN, M.D.
Plain-English Specialty	Licensed & Credentialed Allopathic & Osteopathic Physicians — General Practice NUCC Code: `208D00000X` (General Practice)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	803 E MILBANK AVE, MILBANK, SD, 57252-1413
Practice Telephone / Fax	Tel: (605) 432-4587 \| Fax: (605) 432-4580
Administrative Mailing Address	13516 SODAK RD, WILMOT, SD, 57279-8211
Enumeration & Last Sync	Enumerated: 2006-04-17 \| CMS Record Updated: 2023-03-07

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

803 E MILBANK AVE, MILBANK, SD, 57252-1413

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Plain-English Taxonomy & CMS Crosswalk (208D00000X)

What Does Taxonomy Code 208D00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 208D00000X translates to:
"Licensed & Credentialed Allopathic & Osteopathic Physicians — General Practice"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 01 (Physician/General Practice) • CMS Code 99 (Physician/Undefined Physician type[6])
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified General Practice for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (KANYA VANADURONGVAN, M.D.)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`208D00000X` — General Practice Plain English: Licensed & Credentialed Allopathic & Osteopathic Physicians — General Practice	State: SD \| License: `2408` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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KANYA VANADURONGVAN, M.D. (NPI #1760446603)