Provider Demographics
NPI:1245351808
Name:BEACON COMMUNITY MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:BEACON COMMUNITY MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:213-480-1000
Mailing Address - Street 1:2017 W OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-3705
Mailing Address - Country:US
Mailing Address - Phone:213-480-1000
Mailing Address - Fax:213-401-0018
Practice Address - Street 1:2017 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-3705
Practice Address - Country:US
Practice Address - Phone:213-480-1000
Practice Address - Fax:213-401-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54010174400000X
CA20A8246174400000X
CADC29535111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8099936Medicaid
CA1962477299OtherNPI
CA1891798674OtherNPI
CA1821091661OtherNPI
CAGR0102480Medicaid
CA1962477299OtherNPI
CA8099936Medicaid
Y14165Medicare UPIN