Healthcare Provider Details

I. General information

NPI: 1790501393
Provider Name (Legal Business Name): MEDEX CITY NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2024
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12165 1ST ST
YUCAIPA CA
92399-4357
US

IV. Provider business mailing address

1605 VALLE DEL SOL
REDLANDS CA
92373-7438
US

V. Phone/Fax

Practice location:
  • Phone: 909-809-0289
  • Fax: 855-233-7921
Mailing address:
  • Phone: 909-809-0289
  • Fax: 855-233-7921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JUN RATUNIL CHIONG
Title or Position: CEO/PRESIDENT
Credential: MD, MPH
Phone: 909-809-0289