Healthcare Provider Details

I. General information

NPI: 1578181707
Provider Name (Legal Business Name): PIH HEALTH PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4476 TWEEDY BLVD
SOUTH GATE CA
90280-6359
US

IV. Provider business mailing address

PO BOX 1277
WHITTIER CA
90609-1277
US

V. Phone/Fax

Practice location:
  • Phone: 323-563-9499
  • Fax: 323-583-0956
Mailing address:
  • Phone: 562-789-5401
  • Fax: 562-789-5912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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