Healthcare Provider Details

I. General information

NPI: 1497199772
Provider Name (Legal Business Name): JONATHAN D OU MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5562 PHILADELPHIA ST STE 311
CHINO CA
91710-2499
US

IV. Provider business mailing address

5562 PHILADELPHIA ST STE 311
CHINO CA
91710-2499
US

V. Phone/Fax

Practice location:
  • Phone: 909-465-6342
  • Fax: 855-830-1723
Mailing address:
  • Phone: 909-465-6342
  • Fax: 855-830-1723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA113176
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA113176
License Number StateCA

VIII. Authorized Official

Name: JONATHAN DAVID OU
Title or Position: PRESIDENT
Credential: M.D
Phone: 909-465-6342