Healthcare Provider Details

I. General information

NPI: 1619216553
Provider Name (Legal Business Name): PREMIER HOSPITALIST GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 SAN BERNARDINO RD SUITE 101
UPLAND CA
91786-4912
US

IV. Provider business mailing address

8816 FOOTHILL BLVD STE 103
RANCHO CUCAMONGA CA
91730-7199
US

V. Phone/Fax

Practice location:
  • Phone: 562-236-3432
  • Fax:
Mailing address:
  • Phone: 909-579-6753
  • Fax: 909-694-1045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. YTHANH NGUYEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 909-579-6753