Healthcare Provider Details

I. General information

NPI: 1548028368
Provider Name (Legal Business Name): PEDIATRIC CLINIC DE CHINO HILLS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15944 LOS SERRANOS COUNTRY CLUB DR STE 160
CHINO HILLS CA
91709-3990
US

IV. Provider business mailing address

15944 LOS SERRANOS COUNTRY CLUB DR STE 160
CHINO HILLS CA
91709-3990
US

V. Phone/Fax

Practice location:
  • Phone: 909-606-8893
  • Fax: 909-606-8828
Mailing address:
  • Phone: 909-606-8893
  • Fax: 909-606-8828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HARRY ZIYU ZHAO
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: DO
Phone: 909-606-8893