Active NPI
Russell Paul Dunnum, M.D.
- Specialist
- San Diego, CA
National Provider Identifier
1396856290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- G54999
- Practice address
- 4510 Executive Dr
Suite 107
San Diego, CA 92121-3021 - Phone
- (858) 457-4717
- Fax
- (858) 457-0470
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | G54999 | CA | Primary |
Addresses
Primary practice location
4510 Executive Dr
Suite 107
San Diego, CA 92121-3021
Mailing address
4510 Executive Dr
Suite 107
San Diego, CA 92121-3021
Phone (858) 457-4717
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OOG549990 | 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 |
|---|---|---|---|
| G54999 | CA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407196800000",
"number": "1396856290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4510 EXECUTIVE DR",
"address_2": "SUITE 107",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921213021",
"telephone_number": "858-457-4717",
"fax_number": "858-457-0470"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4510 EXECUTIVE DR",
"address_2": "SUITE 107",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921213021",
"telephone_number": "858-457-4717",
"fax_number": "858-457-0470"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUNNUM",
"first_name": "RUSSELL",
"middle_name": "PAUL",
"name_prefix": "Mr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2014-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "G54999",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "OOG549990",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.