Healthcare Provider Details

I. General information

NPI: 1801551494
Provider Name (Legal Business Name): PIH HEALTH PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 WILSHIRE BLVD STE 205
LOS ANGELES CA
90017-4812
US

IV. Provider business mailing address

PO BOX 1277
LOS ANGELES CA
90001-0277
US

V. Phone/Fax

Practice location:
  • Phone: 562-967-2774
  • Fax: 562-967-2769
Mailing address:
  • Phone: 562-789-5401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

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