IWAN NYOTOWIDJOJO (NPI# 1578976270) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578976270 |
| Entity Type | Individual |
| Full Name | IWAN NYOTOWIDJOJO |
| Other Name | IWAN NYOTO |
| Credential | M.D. |
| Practice Address |
21634 Retreat Pkwy Corona CA 92883-6100 |
| Practice Telephone | 9514936925 |
| Mailing Telephone | 9514936925 |
| Mailing Fax Number | 5206266020 |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2020-02-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | A90249 | CA | Allopathic & Osteopathic Physicians |
| N | 207R00000X | Internal Medicine | R74508 | AZ | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | ARIZONA MEDICAL BOARD TRAINING LICENSE | R74508 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1501 N Campbell Ave, Tucson, AZ 857240001 | 5206267000 | 5206266020 |
| Street Address |
21634 RETREAT PKWY |
| City | CORONA |
| State | CA |
| Zip Code | 92883-6100 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124025598 | Michael T. Mai | Orthopaedic Surgery | 21634 Retreat Pkwy, Corona, CA 92883-6100 | 2005-06-30 |
| 1013561810 | Riverside Medical Clinic, Inc | Family Medicine | 21634 Retreat Pkwy, Corona, CA 92883-6100 | 2019-07-30 |
| 1760043426 | Rmc Surgery Center Inc | Clinic/Center | 21634 Retreat Pkwy, Corona, CA 92883-6100 | 2019-06-24 |
| 1053775684 | Alexander James Geyer | Student in an Organized Health Care Education/Training Program | 21634 Retreat Pkwy, Corona, CA 92883-6100 | 2016-04-10 |
| 1043688633 | Misbah Patel Rasool | Family Medicine | 21634 Retreat Pkwy, Corona, CA 92883-6100 | 2015-09-13 |
| 1609257435 | Poyrung Poysophon | Family Medicine | 21634 Retreat Pkwy, Corona, CA 92883-6100 | 2015-06-17 |
| 1851719512 | Samarjeet Bajwa | Psychiatry & Neurology | 21634 Retreat Pkwy, Corona, CA 92883-6100 | 2014-03-31 |
| 1164783908 | Simran Brar | Internal Medicine | 21634 Retreat Pkwy, Corona, CA 92883-6100 | 2012-06-07 |
| 1750647418 | Pejman Solaimani | Student in an Organized Health Care Education/Training Program | 21634 Retreat Pkwy, Corona, CA 92883-6100 | 2012-04-07 |
| 1063731297 | Kimberly Tustison | Obstetrics & Gynecology | 21634 Retreat Pkwy, Corona, CA 92883-6100 | 2010-05-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710496815 | Onyinye Yvonne Johnson | Nurse Practitioner | 27223 Lasso Way, Corona, CA 92883 | 2017-09-21 |
| 1215376850 | Jennifer Carol Bard | Speech-Language Pathologist | 4194 Floyd Drive, Corona, CA 92883 | 2013-06-17 |
| 1023359619 | Richard Joon Kim | Pharmacist | 4315 Driving Range Rd, Corona, CA 92883 | 2013-03-07 |
| 1740590330 | Kim-thoa Thi Vu | Pharmacist | 2243 Eagle Glen Parkway, Corona, CA 92883 | 2010-10-15 |
| 1114232154 | Always 'tfy' Hospice, Inc. | Hospice Care, Community Based | 9064 Pulsar Court, Ste E, Corona, CA 92883 | 2010-08-14 |
| 1952553844 | Garfield Beach Cvs LLC | Durable Medical Equipment & Medical Supplies | 11950 Depalma Rd, Corona, CA 92883 | 2008-10-22 |
| 1497979280 | Sang C Paik Dds | Dentist | 3811 Bedford Canyon Rd, Suite 105, Corona, CA 92883 | 2007-04-12 |
| 1285615864 | Mallory Leon | Family Medicine | 25085 Pacific Crest Street, Corona, CA 92883 | 2005-11-09 |
| 1326038993 | Chan Woo Lee | Optometrist | 2790 Cabot Drive, Suite 135, Corona, CA 92883 | 2005-10-25 |
| 1659575736 | Optique Optometry, A Professional Corporation | Optometrist | 2790 Cabot Drive, Suite 135, Corona, CA 92883 | 2007-06-13 |
| Find all providers in zip 92883 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235794124 | Nyc Care Center LLC | Internal Medicine | 3806 Junction Blvd Fl 1, Corona, NY 11368-2126 | 2019-05-06 |
| 1174013551 | Centro Medico Perez PC | Internal Medicine | 10324 Roosevelt Ave Ste 306, Corona, NY 11368-1562 | 2018-05-11 |
| 1881056489 | Haidy Adel Tawfik Youssef | Internal Medicine | 1280 Corona Pointe Ct Ste 118, Corona, CA 92879-1770 | 2016-03-23 |
| 1578947750 | Tatiana Flaminia Gomez Lopez | Internal Medicine | 10211 Roosevelt Ave # 4, Corona, NY 11368 | 2015-07-16 |
| 1700265030 | Shahzad Chaudhary | Internal Medicine | 9629 42nd Ave, Corona, NY 11368-2146 | 2015-05-19 |
| 1689088361 | Mustafa Al Lami | Internal Medicine | 111 W Harrison St Unit 246, Corona, CA 92880 | 2014-06-20 |
| 1558599985 | Firas Abubaker Md Inc | Internal Medicine | 160 W Foothill Pkwy Ste 105-221, Corona, CA 92882-8545 | 2009-06-24 |
| 1669614293 | M&m Medical PC | Internal Medicine | 5548 96th St, Corona, NY 11368-3009 | 2009-03-27 |
| 1013155175 | Giorgio Roveran | Internal Medicine | 2045 Compton Ave Ste 101, Corona, CA 92881-7286 | 2009-01-28 |
| 1467604157 | Omprakash Ramani Md PC | Internal Medicine | 59-30 108 Street, #2j Omprakash Ramani Md PC, Corona, NY 11368 | 2008-10-14 |
| Find all providers in CORONA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.