Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Bonar Sofian Mangunsong

Individual provider Physician Assistant · NPI 1437548880

Mr. Bonar Sofian Mangunsong is a Physician Assistant in Loma Linda, California. Qualified in 2015, 11 years ago. Practices with Wound Masters Medical Group Inc, an 11-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
11
Licensed in
CA
In the registry since
2015
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Practice location Address checks out

25340 Park Ave Apt 6
Loma Linda, CA 92354
Phone: (909) 252-6481
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 52249 (CA)

Record details

NPI number1437548880
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJanuary 22, 2015
Last updated in NPPESJanuary 22, 2015

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Wound Masters Medical Group Inc — 11 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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