Healthcare Provider Details

I. General information

NPI: 1235118068
Provider Name (Legal Business Name): CALIFORNIA HEADACHE AND PAIN SPECIALIST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W. LAS TUNAS DR.
SAN GABRIEL CA
91776
US

IV. Provider business mailing address

420 W. LAS TUNAS DR.
SAN GABRIEL CA
91776
US

V. Phone/Fax

Practice location:
  • Phone: 626-457-1688
  • Fax: 626-457-1638
Mailing address:
  • Phone: 626-457-1688
  • Fax: 626-457-1638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberA66257
License Number StateCA

VIII. Authorized Official

Name: MR. CHONGHAO ZHAO
Title or Position: PRESIDENT
Credential: MD
Phone: 626-226-7218