DR. POYRUNG POYSOPHON (NPI# 1609257435) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609257435 |
| Entity Type | Individual |
| Full Name | DR. POYRUNG POYSOPHON |
| Credential | MD |
| Practice Address |
21634 Retreat Pkwy Corona CA 92883-6100 |
| Practice Telephone | 9514936832 |
| Mailing Telephone | 9514936832 |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2020-02-24 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
A015875 | CA | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 331 Ne Thornton Pl, Seattle, WA 981258021 | 2065202405 | |
| 1971 University Avenue, Riverside, CA 92507 | 9513846200 | |
| Eastside Health Center Building B, 1971 University Avenue, Riverside, CA 925079250 | 9513846200 | |
| 7117 Brockton Ave, Riverside, CA 925062658 | 9514936832 |
| Street Address |
21634 RETREAT PKWY |
| City | CORONA |
| State | CA |
| Zip Code | 92883-6100 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124025598 | Michael T. Mai | Orthopaedic Surgery | 21634 Retreat Pkwy, Corona, CA 92883-6100 | 2005-06-30 |
| 1013561810 | Riverside Medical Clinic, Inc | Family Medicine | 21634 Retreat Pkwy, Corona, CA 92883-6100 | 2019-07-30 |
| 1760043426 | Rmc Surgery Center Inc | Clinic/Center | 21634 Retreat Pkwy, Corona, CA 92883-6100 | 2019-06-24 |
| 1053775684 | Alexander James Geyer | Student in an Organized Health Care Education/Training Program | 21634 Retreat Pkwy, Corona, CA 92883-6100 | 2016-04-10 |
| 1043688633 | Misbah Patel Rasool | Family Medicine | 21634 Retreat Pkwy, Corona, CA 92883-6100 | 2015-09-13 |
| 1578976270 | Iwan Nyotowidjojo | Internal Medicine | 21634 Retreat Pkwy, Corona, CA 92883-6100 | 2014-06-10 |
| 1851719512 | Samarjeet Bajwa | Psychiatry & Neurology | 21634 Retreat Pkwy, Corona, CA 92883-6100 | 2014-03-31 |
| 1164783908 | Simran Brar | Internal Medicine | 21634 Retreat Pkwy, Corona, CA 92883-6100 | 2012-06-07 |
| 1750647418 | Pejman Solaimani | Student in an Organized Health Care Education/Training Program | 21634 Retreat Pkwy, Corona, CA 92883-6100 | 2012-04-07 |
| 1063731297 | Kimberly Tustison | Obstetrics & Gynecology | 21634 Retreat Pkwy, Corona, CA 92883-6100 | 2010-05-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710496815 | Onyinye Yvonne Johnson | Nurse Practitioner | 27223 Lasso Way, Corona, CA 92883 | 2017-09-21 |
| 1215376850 | Jennifer Carol Bard | Speech-Language Pathologist | 4194 Floyd Drive, Corona, CA 92883 | 2013-06-17 |
| 1023359619 | Richard Joon Kim | Pharmacist | 4315 Driving Range Rd, Corona, CA 92883 | 2013-03-07 |
| 1740590330 | Kim-thoa Thi Vu | Pharmacist | 2243 Eagle Glen Parkway, Corona, CA 92883 | 2010-10-15 |
| 1114232154 | Always 'tfy' Hospice, Inc. | Hospice Care, Community Based | 9064 Pulsar Court, Ste E, Corona, CA 92883 | 2010-08-14 |
| 1952553844 | Garfield Beach Cvs LLC | Durable Medical Equipment & Medical Supplies | 11950 Depalma Rd, Corona, CA 92883 | 2008-10-22 |
| 1497979280 | Sang C Paik Dds | Dentist | 3811 Bedford Canyon Rd, Suite 105, Corona, CA 92883 | 2007-04-12 |
| 1285615864 | Mallory Leon | Family Medicine | 25085 Pacific Crest Street, Corona, CA 92883 | 2005-11-09 |
| 1326038993 | Chan Woo Lee | Optometrist | 2790 Cabot Drive, Suite 135, Corona, CA 92883 | 2005-10-25 |
| 1659575736 | Optique Optometry, A Professional Corporation | Optometrist | 2790 Cabot Drive, Suite 135, Corona, CA 92883 | 2007-06-13 |
| Find all providers in zip 92883 | ||||
| Taxonomy Code | 207QS0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Sports Medicine |
| A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952673592 | Adam Schulte | Family Medicine | 2250 S Main St Ste 104, Corona, CA 92882-2538 | 2012-01-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447875570 | Nader Sobh Inc | Family Medicine | 11740 San Vicente Blvd Ste 205, Los Angeles, CA 90049-6610 | 2020-06-15 |
| 1124596010 | Cam Md | Family Medicine | 1968 S Coast Hwy # 401, Laguna Beach, CA 92651-3681 | 2018-11-08 |
| 1902289226 | Daesoon Leem | Family Medicine | 15095 Amargosa Rd, Bldg.1, #102, Victorville, CA 92394 | 2015-07-06 |
| 1114313616 | Michelle Sriwongtong | Family Medicine | 834 Castro St, 3, San Francisco, CA 94114-2858 | 2015-04-10 |
| 1225433006 | Harut Madatovian | Family Medicine | 2595 E Washington Blvd Ste 106, Pasadena, CA 91107-1409 | 2014-10-23 |
| 1760801880 | Kyle William Meyer | Family Medicine | 24910 Las Brisas Rd Ste 105, Murrieta, CA 92562 | 2014-04-16 |
| 1720403553 | Dianne Longo | Family Medicine | 1319 Evergreen Ave, Apt N2, Fullerton, CA 92835-2063 | 2014-03-03 |
| 1255760633 | Steven William Marles | Family Medicine | 4265 Tapestry Way, Turlock, CA 95382-7448 | 2013-11-05 |
| 1497098909 | Joshua David Sampson | Family Medicine | 2299 Post St Ste 107, San Francisco, CA 94115-3460 | 2013-04-03 |
| 1699015529 | Andrew Saleh | Family Medicine | 1370 Rosecrans St Ste A, San Diego, CA 92106-2676 | 2013-03-01 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.