NPIMap

Organization Active NPI

Chino Pediatric Medical Group

  • Pediatrics Physician
  • Chino Hills, CA
National Provider Identifier
1962486993
Registry record updated Jul 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
27982 Issued in CA
Legal business name
CHINO PEDIATRIC MEDICAL GROUP
Practice address
15944 Los Serranos Country Club Dr
Suite 220
Chino Hills, CA 91709-3991
Phone
(909) 393-6202
Fax
(909) 393-6204
NPI assigned
Dec 2, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Daryl K Tsai, M.D.NPI 1447235080
Title
Treasurer
Phone
(909) 393-6202

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 27982 CA Primary

Addresses

Primary practice location

15944 Los Serranos Country Club Dr
Suite 220
Chino Hills, CA 91709-3991

Mailing address

15944 Los Serranos Country Club Dr
Suite 220
Chino Hills, CA 91709-3991
Phone (909) 393-6202

Other identifiers 4

IdentifierTypeStateIssuer
00A674780MedicaidCA
1447235080MedicaidCA
00A673880MedicaidCA
1285619825MedicaidCA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1012341Chino Pediatric Medical Group15944 Los Serranos Country Club Dr Ste 220, Chino Hills, CA 91709Certificate of waiverSep 17, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404691200000",
    "number": "1962486993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15944 LOS SERRANOS COUNTRY CLUB DR",
            "address_2": "SUITE 220",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917093991",
            "telephone_number": "909-393-6202",
            "fax_number": "909-363-6204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15944 LOS SERRANOS COUNTRY CLUB DR",
            "address_2": "SUITE 220",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917093991",
            "telephone_number": "909-393-6202",
            "fax_number": "909-393-6204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHINO PEDIATRIC MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-02",
        "last_updated": "2014-07-07",
        "status": "A",
        "authorized_official_last_name": "TSAI",
        "authorized_official_first_name": "DARYL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "909-393-6202",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "27982",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A674780",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447235080",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A673880",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1285619825",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chino Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.