Organization Active NPI

Viruch Vachirakorntong MD Inc

  • Obstetrics & Gynecology Physician
  • Apple Valley, CA
National Provider Identifier
1992754899
Registry record updated Nov 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
VIRUCH VACHIRAKORNTONG MD INC
Practice address
15998 Quantico Rd
Suite a
Apple Valley, CA 92307-1302
Phone
(760) 242-2271
Fax
(760) 242-4491
NPI assigned
May 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2009

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

Authorized official

Name
Viruch Vachirakorntong, M.D.NPI 1659428001
Title
President
Phone
(760) 242-2271

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

15998 Quantico Rd
Suite a
Apple Valley, CA 92307-1302

Mailing address

15998 Quantico Rd
Suite a
Apple Valley, CA 92307-1302
Phone (760) 242-2271

Other identifiers 3

IdentifierTypeStateIssuer
LAB51470FMedicaidCA
00A526560MedicaidCA
00A526561MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060424000653 CA Part B Supplier - Clinic/Group Practice 0941210751 Receives reassigned benefits from 3 practitioners
Practice locations: Apple Valley, CA; Barstow, CA

National Provider Directory

National Provider Directory

Locations

705 E Virginia Way
Ste L
Barstow, CA 92311
Phone (760) 256-0383

36243 Inland Valley Dr
Ste 210
Wildomar, CA 92595
Phone (888) 637-4766

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257724800000",
    "number": "1992754899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15998 QUANTICO RD",
            "address_2": "SUITE A",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923071302",
            "telephone_number": "760-242-2271",
            "fax_number": "760-242-4491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15998 QUANTICO RD",
            "address_2": "SUITE A",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923071302",
            "telephone_number": "760-242-2271",
            "fax_number": "760-242-4491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIRUCH VACHIRAKORNTONG MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-08",
        "last_updated": "2009-11-09",
        "status": "A",
        "authorized_official_last_name": "VACHIRAKORNTONG",
        "authorized_official_first_name": "VIRUCH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "760-242-2271",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LAB51470F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A526560",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A526561",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Apple Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.