Active NPI
David K Dong, M.D.
- Pediatrics Physician
- Moreno Valley, CA
National Provider Identifier
1336155258
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A92705
- Practice address
- 12980 Frederick St Ste I
Moreno Valley, CA 92553-5263 - Phone
- (951) 684-8020
- Fax
- (951) 684-8090
- NPI assigned
- Jul 31, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A92705 | CA | Primary |
Addresses
Primary practice location
12980 Frederick St Ste I
Moreno Valley, CA 92553-5263
Mailing address
264 Highland Springs Ave
Building 1a
Banning, CA 92220-3045
Phone (951) 769-7191
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A927050 | Medicaid | CA |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A92705 | CA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Integrative Medical Center | Pediatrics | Past | Accepting new patients |
| Riverside Healthcare System, L.P. | Past | Accepting new patients | |
| Bolsa Medical Group | Pediatrics | Past | Accepting new patients |
| New Millenium Medical Associates | Pediatrics | Past | Accepting new patients |
| Doctors Hospital of Riverside LLC | Past | Accepting new patients | |
| Stanley H Schwartz MD, Inc | Pediatrics | Past | Accepting new patients |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Interoperability endpoints
- david.dong@bolsamg.directbygreenway.com
Organizations & group practices 6
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.
-
- General Acute Care Hospital
- Riverside, CA
- NPI 1124596382
-
- Pediatrics Physician
- Banning, CA
- NPI 1053530295
-
- Rehabilitation Hospital Unit
- Riverside, CA
- NPI 1053358010
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555286400000",
"number": "1336155258",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "264 HIGHLAND SPRINGS AVE",
"address_2": "BUILDING 1A",
"city": "BANNING",
"state": "CA",
"postal_code": "922203045",
"telephone_number": "951-769-7191",
"fax_number": "951-269-2167"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12980 FREDERICK ST STE I",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925535263",
"telephone_number": "951-684-8020",
"fax_number": "951-684-8090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DONG",
"first_name": "DAVID",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-31",
"last_updated": "2019-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A92705",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A927050",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moreno Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.