Healthcare Provider Details

I. General information

NPI: 1487310280
Provider Name (Legal Business Name): PIH HEALTH PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41210 11TH STREET
PALMDALE CA
93551-1477
US

IV. Provider business mailing address

PO BOX 1277
LOS ANGELES CA
90001-0277
US

V. Phone/Fax

Practice location:
  • Phone: 661-274-4220
  • Fax: 661-274-2777
Mailing address:
  • Phone: 562-789-5401
  • Fax: 562-789-5912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

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