Healthcare Provider Details

I. General information

NPI: 1518109719
Provider Name (Legal Business Name): JONATHAN D OU M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
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 TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA113176
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA113176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: