Healthcare Provider Details

I. General information

NPI: 1144548728
Provider Name (Legal Business Name): WILSHIRE CRESCENT HEIGHTS MEDICAL CENTER A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 WILSHIRE BLVD SUITE 625
BEVERLY HILLS CA
90211-3121
US

IV. Provider business mailing address

2530 S SAN PEDRO ST
LOS ANGELES CA
90011-1520
US

V. Phone/Fax

Practice location:
  • Phone: 310-360-9785
  • Fax: 310-360-0312
Mailing address:
  • Phone: 213-748-0449
  • Fax: 213-748-7928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberA410290
License Number StateCA

VIII. Authorized Official

Name: MALIHE DARDASHTI
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 310-360-9785