Provider Demographics
NPI:1639224306
Name:WILSHIRE ORTHOPAEDIC AND MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:WILSHIRE ORTHOPAEDIC AND MEDICAL ASSOCIATES INC
Other - Org Name:L A WILSHIRE ORTHOPAEDIC AND MEDICAL ASSOCIATES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-250-9900
Mailing Address - Street 1:637 SOUTH LUCAS AVENUE
Mailing Address - Street 2:STE 205
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1912
Mailing Address - Country:US
Mailing Address - Phone:213-250-9900
Mailing Address - Fax:213-250-9380
Practice Address - Street 1:637 SOUTH LUCAS AVENUE
Practice Address - Street 2:STE 205
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1912
Practice Address - Country:US
Practice Address - Phone:213-250-9900
Practice Address - Fax:213-250-9380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty