Provider Demographics
NPI:1023203882
Name:HIGH DESERT WOMENS MEMORIAL MEDICAL CENTER APC
Entity Type:Organization
Organization Name:HIGH DESERT WOMENS MEMORIAL MEDICAL CENTER APC
Other - Org Name:HUNTINGTON PARK CLINICA SANTA MARIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LU-WEI
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-256-6680
Mailing Address - Street 1:2680 E FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4708
Mailing Address - Country:US
Mailing Address - Phone:323-581-4665
Mailing Address - Fax:323-581-0551
Practice Address - Street 1:2680 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4708
Practice Address - Country:US
Practice Address - Phone:323-581-4665
Practice Address - Fax:323-581-0551
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIGH DESERT WOMENS MEMORIAL MEDICAL CENTER APC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-13
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50695174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1023203882Medicaid
CADM453AOtherMEDICARE PTAN