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General NPI Number Information
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NPI Number | 1497199772
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Entity Type | Organization
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Legal Business Name | JONATHAN D OU MD INC
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Dates
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Enumeration Date | 04/17/2013
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Last Update Date | 04/17/2013
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Provider Practice Location Address
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Address Line | 2707 S DIAMOND BAR BLVD SUITE 104
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City | DIAMOND BAR
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State | CA
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Zip | 91765-3500
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Country | US
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Telephone | 909-594-8331
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Fax |
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Provider Business Mailing Address
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Address Line | 2707 S DIAMOND BAR BLVD SUITE 104
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City | DIAMOND BAR
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State | CA
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Zip | 91765-3500
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Country | US
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Telephone | 909-594-8331
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. JONATHAN D. OU
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Credential | M.D.
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Telephone | 909-670-7880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A113176
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A113176
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License Number State | CA
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