Provider Demographics
NPI:1033304894
Name:HIGH DESERT WOMENS MEMORIAL MEDICAL CENTER APC
Entity Type:Organization
Organization Name:HIGH DESERT WOMENS MEMORIAL MEDICAL CENTER APC
Other - Org Name:CLINICA SANTA MARIA ECHO PARK
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:213-482-4400
Mailing Address - Street 1:1571 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-3333
Mailing Address - Country:US
Mailing Address - Phone:213-482-4400
Mailing Address - Fax:213-482-5100
Practice Address - Street 1:625 W COLLEGE ST STE 105
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-1650
Practice Address - Country:US
Practice Address - Phone:213-265-7433
Practice Address - Fax:213-265-7531
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
CA1033304894Medicaid
CADM453AOtherMEDICARE PTAN