Provider Demographics
NPI:1053350884
Name:CHINO MEDICAL GROUP, INC
Entity type:Organization
Organization Name:CHINO MEDICAL GROUP, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PRASAD
Authorized Official - Middle Name:
Authorized Official - Last Name:JEEREDDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-591-6446
Mailing Address - Street 1:5475 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2609
Mailing Address - Country:US
Mailing Address - Phone:909-591-6446
Mailing Address - Fax:909-591-1309
Practice Address - Street 1:5475 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2609
Practice Address - Country:US
Practice Address - Phone:909-591-6446
Practice Address - Fax:909-591-1309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy