Healthcare Provider Details

I. General information

NPI: 1245520493
Provider Name (Legal Business Name): CORONA PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 S MAIN ST SUITE 200
CORONA CA
92882-2531
US

IV. Provider business mailing address

2815 S MAIN ST SUITE 200
CORONA CA
92882-2531
US

V. Phone/Fax

Practice location:
  • Phone: 951-736-5437
  • Fax: 951-736-5429
Mailing address:
  • Phone: 951-736-5437
  • Fax: 951-736-5429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG78754
License Number StateCA

VIII. Authorized Official

Name: DR. MIHWA YOO
Title or Position: OWNER
Credential: MD
Phone: 951-255-1796