Provider Demographics
NPI:1235118068
Name:CALIFORNIA HEADACHE AND PAIN SPECIALIST, INC.
Entity Type:Organization
Organization Name:CALIFORNIA HEADACHE AND PAIN SPECIALIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHONGHAO
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-226-7218
Mailing Address - Street 1:420 W. LAS TUNAS DR.
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776
Mailing Address - Country:US
Mailing Address - Phone:626-457-1688
Mailing Address - Fax:626-457-1638
Practice Address - Street 1:420 W. LAS TUNAS DR.
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776
Practice Address - Country:US
Practice Address - Phone:626-457-1688
Practice Address - Fax:626-457-1638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA662572084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H76377Medicare UPIN
CAH76377Medicare UPIN
W19293Medicare PIN
CAW19293Medicare PIN