Active NPI
Kwonta Phatiphong
- Marriage & Family Therapist
- Pomona, CA
National Provider Identifier
1003288564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 96278
- Practice address
- 2008 N Garey Ave
Pomona, CA 91767-2722 - Phone
- (909) 623-6131
- NPI assigned
- Oct 23, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 96278 | CA | Primary |
Addresses
Primary practice location
2008 N Garey Ave
Pomona, CA 91767-2722
Mailing address
PO Box 1764
Chino Hills, CA 91709-0059
Phone (909) 671-9004
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 96278 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tri-City Mental Health Center | Past | Accepting new patients | |
| Tri-City Mental Health Authority | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Pomona, CA
- NPI 1346304920
-
- Case Management Agency
- Pomona, CA
- NPI 1255651501
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595289600000",
"number": "1003288564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1764",
"city": "CHINO HILLS",
"state": "CA",
"postal_code": "917090059",
"telephone_number": "909-671-9004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2008 N GAREY AVE",
"city": "POMONA",
"state": "CA",
"postal_code": "917672722",
"telephone_number": "909-623-6131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHATIPHONG",
"first_name": "KWONTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-10-23",
"last_updated": "2020-07-21",
"certification_date": "2020-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "96278",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pomona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.