| Inland Valley Infectious Disease Medical Group Inc | |
|
255 E Bonita Ave Bldg 1b Pomona CA 91767-1923 | |
| (909) 275-7470 | |
| (909) 971-4532 |
| Full Name | Inland Valley Infectious Disease Medical Group Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 255 E Bonita Ave Bldg 1b, Pomona, California |
| Authorized Official Name and Position | John Mourani (PRESIDENT) |
| Authorized Official Contact | 9519296260 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Inland Valley Infectious Disease Medical Group Inc 310 N Indian Hill Blvd 801 Claremont CA 91711-4611 Ph: (909) 275-7470 | Inland Valley Infectious Disease Medical Group Inc 255 E Bonita Ave Bldg 1b Pomona CA 91767-1923 Ph: (909) 275-7470 |
| NPI Number | 1417995598 |
|---|---|
| Provider Enumeration Date | 06/02/2006 |
| Last Update Date | 05/03/2023 |
| Medicare PECOS PAC ID | 2365455391 |
|---|---|
| Medicare Enrollment ID | O20060717000191 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417995598 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| Provider Name | John P Mourani |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1962460154 PECOS PAC ID: 4587633250 Enrollment ID: I20070206000723 |
| Provider Name | Kerry N Gott |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1013955186 PECOS PAC ID: 0749282689 Enrollment ID: I20070402000795 |
| Provider Name | Daniel P Gluckstein |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1598703654 PECOS PAC ID: 6103828041 Enrollment ID: I20070406000403 |
| Provider Name | Irene Bakman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881856995 PECOS PAC ID: 4789720178 Enrollment ID: I20091015000579 |
| Provider Name | Kanokrat Suksompoth |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831109131 PECOS PAC ID: 7911905773 Enrollment ID: I20141028001582 |
| Provider Name | Ossama Maloule |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1033226949 PECOS PAC ID: 8729381629 Enrollment ID: I20160718000644 |
| Provider Name | Ye Min Oo |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1972975241 PECOS PAC ID: 0042568339 Enrollment ID: I20230210000209 |
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