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HOLLENBERG AGRAWAL KNOLL WARREN HONG FUNG TILLIS KAUSHAL MDS NPI 1366447781


NPI Information

NPI: 1366447781
Provider Name: HOLLENBERG AGRAWAL KNOLL WARREN HONG FUNG TILLIS KAUSHAL MDS

Doing Business As: POMONA PEDIATRICS

Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 05D0677550

Address:
250 W BONITA AVE
#200
POMONA, CA
ZIP 91767
Phone: (909) 620-1935
Get Directions

HOLLENBERG AGRAWAL KNOLL WARREN HONG FUNG TILLIS KAUSHAL MDS is a pediatrics in Pomona, CA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. HOLLENBERG AGRAWAL KNOLL WARREN HONG FUNG TILLIS KAUSHAL MDS NPI is 1366447781. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Pomona Pediatrics.

The provider's business location address is:

250 W BONITA AVE
#200
POMONA, CA
ZIP 91767-850
Phone: (909) 620-1935
Fax: (909) 865-7688

The provider's authorized official is Jim Hollenberg .
The authorized official title is Staff/it and has the following contact phone number (909) 620-1935.

The CLIA number assigned to this NPI record is 05D0677550 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/14/2005 and was last updated on 7/30/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1GR0066720OTHERCALIFORNIAMEDI CAL GROUP NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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