MEDICARE: PEDIATRIC CLINIC DE CHINO HILLS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	A94357	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467708719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC CLINIC DE CHINO HILLS

Provider Business Mailing Address
First Line	:	15944 LOS SERRANOS COUNTRY CLUB DR
Second Line	:	SUITE 160
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-3993
Country	:	US
Telephone Number	:	909-606-8893
Fax Number	:	909-606-8828

Provider Business Practice Location Address
First Line	:	15944 LOS SERRANOS COUNTRY CLUB DR
Second Line	:	SUITE 160
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-3993
Country	:	US
Telephone Number	:	909-606-8893
Fax Number	:	909-606-8828

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HUA BAI
Credential	:
Telephone Number	:	909-606-8893

Provider Enumeration Date	:	07/24/2012
Last Update Date	:	07/24/2012

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Directions to “PEDIATRIC CLINIC DE CHINO HILLS ” Practice Location

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