| NPI | 1407964919 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY HONG VO Office Manager 909-988-2555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A44599) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA 14845) |
| 363AM0700X Physician Assistant, Medical (Licence: CA PA 16663) | |
| 363L00000X Nurse Practitioner (Licence: CA NP 13818) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2020-08-22 |