Healthcare Provider Details

I. General information

NPI: 1356405591
Provider Name (Legal Business Name): WESTERN PAIN AND HEADACHE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 SOUTH GARFIELD AVE. SUITE 205
ALHAMABRA CA
91801
US

IV. Provider business mailing address

1234 SOUTH GARFIELD AVE. SUITE 205
ALHAMABRA CA
91801
US

V. Phone/Fax

Practice location:
  • Phone: 626-457-6700
  • Fax: 626-457-6750
Mailing address:
  • Phone: 626-457-6700
  • Fax: 626-457-6750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA66257
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA90819
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHONG-HAO ZHAO
Title or Position: PRESIDENT/ MEDICAL DIRECTOR
Credential: MD, PHD, DABMA
Phone: 818-842-1688