Provider Demographics
NPI:1043261654
Name:BANGSIL, RONALD YUSI (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:YUSI
Last Name:BANGSIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MARINER CV
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1662
Mailing Address - Country:US
Mailing Address - Phone:714-226-0770
Mailing Address - Fax:714-489-2170
Practice Address - Street 1:2501 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-6143
Practice Address - Country:US
Practice Address - Phone:714-327-6806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66106207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BB6640191OtherDEA
BB6640191OtherDEA
COA661060Medicare ID - Type Unspecified