Healthcare Provider Details

I. General information

NPI: 1710016530
Provider Name (Legal Business Name): INLAND PSYCHIATRIC MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 MISSOURI CT
REDLANDS CA
92373-8083
US

IV. Provider business mailing address

PO BOX 8160
REDLANDS CA
92375-1360
US

V. Phone/Fax

Practice location:
  • Phone: 909-307-1320
  • Fax: 909-798-3607
Mailing address:
  • Phone: 909-335-3026
  • Fax: 909-335-3167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SYAM KUNAM
Title or Position: CEO
Credential: M.D.
Phone: 909-335-3026