Healthcare Provider Details

I. General information

NPI: 1437815313
Provider Name (Legal Business Name): PIH HEALTH PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 N 13TH AVE STE 9
UPLAND CA
91786-4963
US

IV. Provider business mailing address

PO BOX 1277
LOS ANGELES CA
90001-0277
US

V. Phone/Fax

Practice location:
  • Phone: 909-949-3977
  • Fax: 213-977-1180
Mailing address:
  • Phone: 562-789-5401
  • Fax: 562-789-5912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

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