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3550 E Philadelphia Street Suite # 150 Ontario CA 91761 | |
| (909) 773-0022 | |
| (866) 672-8222 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 3550 E Philadelphia Street, Ontario, California |
| Authorized Official Name and Position | Jack X Wu (SECRETARY) |
| Authorized Official Contact | 9097730022 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3550 E Philadelphia Street Suite # 150 Ontario CA 91761 Ph: (909) 773-0022 | 3550 E Philadelphia Street Suite # 150 Ontario CA 91761 Ph: (909) 773-0022 |
| NPI Number | 1548356884 |
|---|---|
| Provider Enumeration Date | 10/05/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548356884 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 20A8127 (California) | Primary |
| 207R00000X | Internal Medicine | A69486 (California) | Primary |
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