=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285826669
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PACIFIC HORIZON MEDICAL CENTER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2007
-----------------------------------------------------
Last Update Date | 02/01/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 316 E LAS TUNAS DR STE 102 316 E. LAS TUNAS DRIVE, SUITE 102
-----------------------------------------------------
City | SAN GABRIEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91776-1535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-300-8880
-----------------------------------------------------
Fax | 626-300-8811
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 316 E LAS TUNAS DR STE 102 316 E LAS TUNAS DR STE 102
-----------------------------------------------------
City | SAN GABRIEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91776-1535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-300-8880
-----------------------------------------------------
Fax | 626-300-8811
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | DR. ZHI ZENG
-----------------------------------------------------
Credential | MD, PHD
-----------------------------------------------------
Telephone | 626-300-8880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | A70119
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------