Individual
DR. POYRUNG POYSOPHON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
21634 RETREAT PKWY, CORONA, CA 92883-6100
(951) 493-6832
Mailing address
21634 RETREAT PKWY, CORONA, CA 92883-6100
(951) 493-6832
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
A015875
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/17/2015
Last updated
12/08/2021
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