Provider Demographics
NPI:1205181757
Name:ORANGE PSYCHIATRIC MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:ORANGE PSYCHIATRIC MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAI
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHUNDU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-737-1917
Mailing Address - Street 1:770 MAGNOLIA AVE
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3121
Mailing Address - Country:US
Mailing Address - Phone:951-737-1917
Mailing Address - Fax:951-735-4105
Practice Address - Street 1:4000 14TH ST
Practice Address - Street 2:SUITE 310A
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4018
Practice Address - Country:US
Practice Address - Phone:951-276-1100
Practice Address - Fax:951-276-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X, 103TC0700X, 1041C0700X, 106H00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty