Healthcare Provider Details

I. General information

NPI: 1962724039
Provider Name (Legal Business Name): PIH HEALTH PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S HARBOR BLVD SUITE A
LA HABRA CA
90631-7577
US

IV. Provider business mailing address

P O BOX 1277
WHITTIER CA
90609-1277
US

V. Phone/Fax

Practice location:
  • Phone: 714-879-3400
  • Fax: 714-441-1998
Mailing address:
  • Phone: 562-789-5401
  • Fax: 562-789-5912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25691
License Number StateCA

VIII. Authorized Official

Name: DR. KEITH S MIYAMOTO
Title or Position: PRESIDENT
Credential: MD
Phone: 562-789-5401