Basic Information
| Provider Information | |||||||||
| NPI: | 1811376502 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BRIGHT HEALTH PHYSICIANS OF PIH | ||||||||
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| OtherOrganizationName: | PIH HEALTH PHYSICIANS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1277 | ||||||||
| Address2: | |||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906091277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627895401 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1850 S AZUSA AVE | ||||||||
| Address2: | SUITE 88 | ||||||||
| City: | HACIENDA HEIGHTS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917456813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269643040 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2015 | ||||||||
| LastUpdateDate: | 05/05/2017 | ||||||||
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| AuthorizedOfficialLastName: | MIYAMOTO | ||||||||
| AuthorizedOfficialFirstName: | KEITH | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5627895401 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.