DR. KHOMTHORN P CUNVONG (DO) – Student in an Organized Health Care Education/Training Program, NPI 1396361580

DR. KHOMTHORN P CUNVONG (DO) is a healthcare provider. based in Arlington, Texas. specializing in INTERNAL MEDICINE. They hold the professional credentials DO. The NPI Number for DR. KHOMTHORN P CUNVONG (DO) is 1396361580

Main info

Male
6 Years Of Experience
Accepts Medicare Assignment
Name
DR. KHOMTHORN P CUNVONG (DO)
NPI
1396361580
Phone
(682) 509-6200
Address
3301 MATLOCK RD
Enumeration Date
23 June 2020
Last Update Date
23 June 2020

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9072761131
Graduation Year
2020 (6 years ago)
PAC ID
9133567068
Group Practice PAC ID
5395100598
Professional Enrollment ID
I20240410003168
Address ID
AK995082932AN2801XRDXX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience25
Completeness75
Years active:5State licenses:0Digital endpointsOther names

13,297 INTERNAL MEDICINE in TX

Provider Addresses for DR. KHOMTHORN P CUNVONG (DO)

  • 3301 MATLOCK RD

    ARLINGTON, TX 760152908

    Phone: (682) 509-6200

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-04-10

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240410003168IInternal MedicineAKTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 76015)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 5395100598View full group profile
NameSpecialtyState
Internal MedicineMT
Internal MedicineFL
Emergency MedicineOR
Internal MedicineMI
Physician AssistantOR
Internal Medicine, HospitalistNY
Internal MedicineID
Physician AssistantOR
Internal Medicine, HospitalistNY
Internal MedicineMD

Reviews

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Frequently asked questions

Can I cross-check DR. KHOMTHORN P CUNVONG (DO) using NPI 1396361580?
NPI 1396361580 belongs to DR. KHOMTHORN P CUNVONG (DO); compare other details if you need extra assurance.
Is there an active status for DR. KHOMTHORN P CUNVONG (DO)?
For scheduling context, DR. KHOMTHORN P CUNVONG (DO) is shown as active in the registry.
How would a patient describe DR. KHOMTHORN P CUNVONG (DO)'s focus?
For DR. KHOMTHORN P CUNVONG (DO), the primary taxonomy reads as Student in an Organized Health Care Education/Training Program. Clinical services aligned with this taxonomy classification.
Is DR. KHOMTHORN P CUNVONG (DO) located near Arlington?
DR. KHOMTHORN P CUNVONG (DO) currently maps to Arlington, Texas in this extract.
Can I trust this NPI listing for DR. KHOMTHORN P CUNVONG (DO)?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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