=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215497276
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DARVIN BUNHOR MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2019
-----------------------------------------------------
Last Update Date | 11/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1818 N ORANGE GROVE AVE STE 200
-----------------------------------------------------
City | POMONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91767-3028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-622-6433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1312 N REUBENS CIR
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92867-5239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-875-0952
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 191307
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------