Provider Demographics
NPI:1356405591
Name:WESTERN PAIN AND HEADACHE CENTER, INC.
Entity type:Organization
Organization Name:WESTERN PAIN AND HEADACHE CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHONG-HAO
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD, DABMA
Authorized Official - Phone:818-842-1688
Mailing Address - Street 1:1234 SOUTH GARFIELD AVE.
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ALHAMABRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801
Mailing Address - Country:US
Mailing Address - Phone:626-457-6700
Mailing Address - Fax:626-457-6750
Practice Address - Street 1:1234 SOUTH GARFIELD AVE.
Practice Address - Street 2:SUITE 205
Practice Address - City:ALHAMABRA
Practice Address - State:CA
Practice Address - Zip Code:91801
Practice Address - Country:US
Practice Address - Phone:626-457-6700
Practice Address - Fax:626-457-6750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 208100000X, 2085R0202X, 122300000X, 103TC0700X
CAA90819207LP2900X
CAA66257174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA71882OtherPIN