Individual provider Active NPI

Tiranun Rungvivatjarus, M.D.

  • Pediatrics Physician
  • San Diego, CA
National Provider Identifier
1407276363
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A141353 Issued in CA
Practice address
3020 Childrens Way
San Diego, CA 92123-4223
Phone
(858) 966-5841
NPI assigned
Apr 18, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A141353 CA Primary

Addresses

Primary practice location

3020 Childrens Way
San Diego, CA 92123-4223

Mailing address

3020 Childrens Way # Mc5064
San Diego, CA 92123-4223
Phone (858) 966-5841

Other practice location 1

3020 Children's Way, MC 5124
San Diego, CA 92123
Phone (858) 966-6764

Other practice location 2

3020 Children's Way, MC 5124
San Diego, CA 92123
Phone (858) 966-6764

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160715001767 CA Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 5395037022

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A141353CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Marilyn Kaufhold, M.D., a Medical Corporation Past Accepting new patients
Rady Children'S Hospital San Diego 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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1397779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1407276363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 CHILDRENS WAY # MC5064",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234223",
            "telephone_number": "858-966-5841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 CHILDRENS WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234223",
            "telephone_number": "858-966-5841"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3020 Children's Way, MC 5124",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "92123",
            "country_code": "US",
            "telephone_number": "858-966-6764",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3020 Children's Way, MC 5124",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "92123",
            "country_code": "US",
            "telephone_number": "858-966-6764",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUNGVIVATJARUS",
        "first_name": "TIRANUN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-18",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A141353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.