1124104427 NPI number — WESTWOOD MEDICAL GROUP,INC.

Table of content: (NPI 1124104427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124104427 NPI number — WESTWOOD MEDICAL GROUP,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTWOOD MEDICAL GROUP,INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124104427
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 S VIRGIL AVE
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90020-1415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-739-0007
Provider Business Mailing Address Fax Number:
213-739-0011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 S VIRGIL AVE
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90020-1415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-739-0007
Provider Business Practice Location Address Fax Number:
213-739-0011
Provider Enumeration Date:
10/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
SONWOO
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
213-739-0007

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  A78554 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RR0500X , with the licence number: A78556 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)