Provider Demographics
NPI:1063636876
Name:WHITTIER FEMALE MEDICAL CLINIC
Entity Type:Organization
Organization Name:WHITTIER FEMALE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:PURDOM
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:562-463-7742
Mailing Address - Street 1:PO BOX 9151
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90608-9151
Mailing Address - Country:US
Mailing Address - Phone:562-463-7742
Mailing Address - Fax:
Practice Address - Street 1:11807 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-3941
Practice Address - Country:US
Practice Address - Phone:562-463-7742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A211801Medicaid
CAA8234Medicare UPIN
CA00A211801Medicaid