Provider Demographics
NPI:1851092035
Name:PRIMECARE MEDICAL GROUP OF CHINO VALLEY
Entity Type:Organization
Organization Name:PRIMECARE MEDICAL GROUP OF CHINO VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HONZEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-573-6031
Mailing Address - Street 1:5562 PHILADELPHIA ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2482
Mailing Address - Country:US
Mailing Address - Phone:909-573-6031
Mailing Address - Fax:
Practice Address - Street 1:5562 PHILADELPHIA ST STE 200
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2482
Practice Address - Country:US
Practice Address - Phone:909-573-6031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty