Bonar Sofian Mangunsong

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

52249 Issued in CA

Practice address

25340 Park Ave Apt 6
Loma Linda, CA 92354

Phone

(909) 252-6481

NPI assigned

Jan 22, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wound Masters Medical Group IncGroup PAC ID 8224307053, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Wound Masters Medical Group Inc

  • Surgery Physician
  • Ontario, CA
  • NPI 1376063461
  Medicare reassignment Care Compare group
• WT Health of California LLC

  • Infectious Disease Physician
  • Los Angeles, CA
  • NPI 1063201655
  Medicare reassignment NPD
• American Current Care of California, a Medical Corporation

  • Clinic/Center
  • Los Angeles, CA
  • NPI 1750573622
  Medicare reassignment
• Minghsun Liu, M.D., PC

  • Infectious Disease Physician
  • Los Angeles, CA
  • NPI 1518309368
  Medicare reassignment
• Wound Doctors

  • Surgery Physician
  • Inglewood, CA
  • NPI 1679293724
  Medicare reassignment
• American Current Care of California, a Medical Corporation

  • Urgent Care Clinic/Center
  • Stockton, CA
  • NPI 1669948055
  NPD
• American Current Care of California, a Medical Corporation

  • Urgent Care Clinic/Center
  • Ontario, CA
  • NPI 1811464084
  NPD

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

{
    "created_epoch": "1421884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421884800000",
    "number": "1437548880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25340 PARK AVE APT 6",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542339",
            "telephone_number": "909-252-6481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25340 PARK AVE APT 6",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "92354",
            "telephone_number": "909-252-6481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGUNSONG",
        "first_name": "BONAR",
        "middle_name": "SOFIAN",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-01-22",
        "last_updated": "2015-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "52249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carlo Manalo, M.D.
• Marian Amameda Manansala
• Krish J Manchandia, M.D.
• Ravi Mandapati, M.D.
• Astkhik Mangasarian, DO
• Victoria Mangunsong, PT
• Christina T Manh, M.D.
• Kristyn Anne Mannoia, M.D.
• Curtis Manolesco
• Jared R Manrique

• Physician Assistant in Loma Linda, CA
• Providers in Loma Linda, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.