DR. POYRUNG POYSOPHON


Address: 21634 Retreat Pkwy, Corona, CA 92883-6100
Phone: 9514936832

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).

Provider Overview

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

Taxonomy

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

Provider Secondary Practice Location

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

Office Location

Street Address 21634 RETREAT PKWY
City CORONA
State CA
Zip Code 92883-6100

Providers in the same location

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
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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 207QS0010X
Grouping Allopathic & Osteopathic Physicians
Classification Family Medicine
Specialization Sports Medicine

Taxonomy Definition

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.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1952673592 Adam Schulte Family Medicine 2250 S Main St Ste 104, Corona, CA 92882-2538 2012-01-27

Providers in the same taxonomy and state

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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Competitor

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City CORONA
Zip Code 92883

Improve Information

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Dataset Information

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.

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