Healthcare Provider Details

I. General information

NPI: 1265829261
Provider Name (Legal Business Name): DIAMOND INTEGRATED MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19239 COLIMA RD
ROWLAND HEIGHTS CA
91748-3005
US

IV. Provider business mailing address

19239 COLIMA RD
ROWLAND HEIGHTS CA
91748-3005
US

V. Phone/Fax

Practice location:
  • Phone: 626-581-7898
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA124101
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANNA XIBIN CHENG
Title or Position: CEO
Credential: M.D.
Phone: 646-851-8268