Healthcare Provider Details

I. General information

NPI: 1922103142
Provider Name (Legal Business Name): WILSHIRE PHARMCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26611 CABOT RD STE B
LAGUNA HILLS CA
92653-7031
US

IV. Provider business mailing address

26611 CABOT RD STE B
LAGUNA HILLS CA
92653-7031
US

V. Phone/Fax

Practice location:
  • Phone: 949-348-7900
  • Fax: 949-348-7922
Mailing address:
  • Phone: 949-348-7900
  • Fax: 949-348-7922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL KYONG YOL LEE
Title or Position: PRESIDENT/CEO
Credential: PHARM.D.
Phone: 949-348-7900