Active NPI
Kristy Samnang Chann, PMHNP
- Psychiatric/Mental Health Nurse Practitioner
- San Bernardino, CA
National Provider Identifier
1396673612
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- 95039303
- Practice address
- 1470 Pumalo St
San Bernardino, CA 92404-4328 - Phone
- (909) 765-6820
- NPI assigned
- May 8, 2026
- 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 |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 95039303 | CA | Primary |
Addresses
Primary practice location
1470 Pumalo St
San Bernardino, CA 92404-4328
Mailing address
1470 Pumalo St
San Bernardino, CA 92404-4328
Phone (909) 765-6820
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95039303 | CA | MD | Psychiatric/Mental Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1778198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1778198400000",
"number": "1396673612",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1470 PUMALO ST",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924044328",
"telephone_number": "909-765-6820"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1470 PUMALO ST",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924044328",
"telephone_number": "909-765-6820"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHANN",
"first_name": "KRISTY",
"middle_name": "SAMNANG",
"credential": "PMHNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2026-05-08",
"last_updated": "2026-05-08",
"certification_date": "2026-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "CA",
"license": "95039303",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.