Provider Demographics
NPI:1497199772
Name:JONATHAN D OU MD INC
Entity Type:Organization
Organization Name:JONATHAN D OU MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:OU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-670-7880
Mailing Address - Street 1:2707 S DIAMOND BAR BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3500
Mailing Address - Country:US
Mailing Address - Phone:909-594-8331
Mailing Address - Fax:
Practice Address - Street 1:2707 S DIAMOND BAR BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3500
Practice Address - Country:US
Practice Address - Phone:909-594-8331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113176207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty