Provider Demographics
NPI:1568808772
Name:WHALEN MEDICAL CORPORATION
Entity Type:Organization
Organization Name:WHALEN MEDICAL CORPORATION
Other - Org Name:FLEXOGENIX, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:WHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-695-6330
Mailing Address - Street 1:7422 GARVEY AVE UNIT 203
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2974
Mailing Address - Country:US
Mailing Address - Phone:213-455-7804
Mailing Address - Fax:213-261-3816
Practice Address - Street 1:1000 S HOPE ST STE 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-4057
Practice Address - Country:US
Practice Address - Phone:213-455-7804
Practice Address - Fax:213-261-3816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208100000X
CAA860742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6885720001Medicare NSC
CAHI609AMedicare PIN