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: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 S DIAMOND BAR BLVD SUITE 104
DIAMOND BAR CA
91765-3500
US

IV. Provider business mailing address

2707 S DIAMOND BAR BLVD SUITE 104
DIAMOND BAR CA
91765-3500
US

V. Phone/Fax

Practice location:
  • Phone: 909-594-8331
  • Fax:
Mailing address:
  • Phone: 909-594-8331
  • Fax:

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: DR. JONATHAN D. OU
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 909-670-7880