Provider Demographics
NPI:1134294002
Name:WHITTIER SURGICAL ASSOC. INC A MEDICAL GROUP
Entity Type:Organization
Organization Name:WHITTIER SURGICAL ASSOC. INC A MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNITH
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-945-1396
Mailing Address - Street 1:7957 PAINTER AVE
Mailing Address - Street 2:#102
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-2434
Mailing Address - Country:US
Mailing Address - Phone:562-945-1396
Mailing Address - Fax:562-945-0331
Practice Address - Street 1:7957 PAINTER AVE
Practice Address - Street 2:#102
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-2434
Practice Address - Country:US
Practice Address - Phone:562-945-1396
Practice Address - Fax:562-945-0331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41918208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW3857Medicare PIN