NPIMap

Individual provider Active NPI

Amarin Kongchalalai, MD

  • Pulmonary Disease Physician
  • Montclair, CA
National Provider Identifier
1649376534
Registry record updated Apr 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
A67705 Issued in CA
Practice address
9655 Monte Vista Ave
#402
Montclair, CA 91763
Phone
(909) 626-1205
Fax
(909) 625-1977
NPI assigned
Sep 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X A67705 CA Primary

Addresses

Primary practice location

9655 Monte Vista Ave
#402
Montclair, CA 91763

Mailing address

9655 Monte Vista Ave
#402
Montclair, CA 91763
Phone (909) 626-1205

Other identifiers 1

IdentifierTypeStateIssuer
00A677050MedicaidCA

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)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A67705CAMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Chino Medical Group, Inc Past Accepting new patients
San Antonio Regional Hospital Past Accepting new patients
Prime Healthcare Services - Montclair, LLC Past Accepting new patients
Pomona Valley Hospital Medical Center Past Accepting new patients
Yong Luke Lee Medical Corporation Past Accepting new patients

Organizations & group practices 5

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": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240358400000",
    "number": "1649376534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9655 MONTE VISTA AVE",
            "address_2": "#402",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "91763",
            "telephone_number": "909-626-1205",
            "fax_number": "909-625-1977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9655 MONTE VISTA AVE",
            "address_2": "#402",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "91763",
            "telephone_number": "909-626-1205",
            "fax_number": "909-625-1977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONGCHALALAI",
        "first_name": "AMARIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-16",
        "last_updated": "2009-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "CA",
            "license": "A67705",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A677050",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montclair, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.