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

Emanuel Bambang Kristianto, MD

Individual provider Family Medicine Physician · NPI 1063589075

Emanuel Bambang Kristianto, MD is registered under Family Practice in Riverside, California. Qualified in 1995, 31 years ago. Practices with Southern California Permanente Medical Group, an 11,242-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
31
Licensed in
CA
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

10800 Magnolia Ave
Riverside, CA 92505-3043
Phone: (909) 353-2000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence A88106 (CA)

Record details

NPI number1063589075
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedNovember 29, 2006
Last updated in NPPESDecember 3, 2021

Medicare enrollment

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

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 1995 (31 years in practice)
Group practice Southern California Permanente Medical Group — 11242 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Colleagues at Southern California Permanente Medical Group

Clinicians the CMS Doctors & Clinicians file lists under the same group practice. CMS counts 11242 clinicians in the practice; 12 are shown here.

Other providers in Riverside