Active NPI
Russelle Chung
- Licensed Psychiatric Technician
- Rialto, CA
National Provider Identifier
1982025904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Psychiatric Technician
- License
- PT33524
- Practice address
- 850 E Foothill Blvd
Rialto, CA 92376-5230 - Phone
- (909) 421-9470
- Fax
- (909) 873-4461
- NPI assigned
- Dec 17, 2013
- Last updated
- Dec 17, 2013
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Licensed Psychiatric Technician | 167G00000X | PT33524 | CA | Primary |
Addresses
Primary practice location
850 E Foothill Blvd
Rialto, CA 92376-5230
Mailing address
850 E Foothill Blvd
Rialto, CA 92376-5230
Phone (909) 421-9470
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT33524 | CA | MD | Licensed Psychiatric Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1387238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1387238400000",
"number": "1982025904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "850 E FOOTHILL BLVD",
"city": "RIALTO",
"state": "CA",
"postal_code": "923765230",
"telephone_number": "909-421-9470",
"fax_number": "909-873-4461"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "850 E FOOTHILL BLVD",
"city": "RIALTO",
"state": "CA",
"postal_code": "923765230",
"telephone_number": "909-421-9470",
"fax_number": "909-873-4461"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHUNG",
"first_name": "RUSSELLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-12-17",
"last_updated": "2013-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "167G00000X",
"taxonomy_group": "",
"desc": "Licensed Psychiatric Technician",
"state": "CA",
"license": "PT33524",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rialto, CA
- Min Jeong Cho, DDS
- Kang Il Choi, DDS
- Norman Yuh Wei Chow, MD
- Rhonda Maurean Christian
- Linda Kosisochukwu Chude, MD
- CHW So. California (St. Bernardine Medical Center)
- Doreen Ann Cisneros
- City of Rialto
- Aaron Maurice Clayton
- Cohen Sedgh, Manavi & Pakravan Dental Corporation (West Coast Dental Group of Rialto)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.