Provider Demographics
NPI:1255513024
Name:WORLD MEDICAL CENTER INC
Entity type:Organization
Organization Name:WORLD MEDICAL CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALDRIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-618-4567
Mailing Address - Street 1:PO BOX 251615
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-9243
Mailing Address - Country:US
Mailing Address - Phone:310-618-4567
Mailing Address - Fax:310-838-2365
Practice Address - Street 1:2701 OCEAN PARK BLVD
Practice Address - Street 2:SUITE 119B
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5200
Practice Address - Country:US
Practice Address - Phone:310-396-4543
Practice Address - Fax:310-396-6109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77053261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain