Provider Demographics
NPI:1720232465
Name:PIH HEALTH PHYSICIANS
Entity Type:Organization
Organization Name:PIH HEALTH PHYSICIANS
Other - Org Name:BRIGHT HEALTH PHYSICIANS OF PIH
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:S
Authorized Official - Last Name:MIYAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-789-5401
Mailing Address - Street 1:P O BOX 1277
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90609-1277
Mailing Address - Country:US
Mailing Address - Phone:562-906-6470
Mailing Address - Fax:562-946-9465
Practice Address - Street 1:12522 LAMBERT RD
Practice Address - Street 2:SUITE D
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-2758
Practice Address - Country:US
Practice Address - Phone:562-789-5420
Practice Address - Fax:562-967-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA70417OtherLICENSE