Healthcare Provider Details

I. General information

NPI: 1366759904
Provider Name (Legal Business Name): WILSHIRE CARDIOLOGY GROUP, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S VIRGIL AVE STE. 200
LOS ANGELES CA
90020-1446
US

IV. Provider business mailing address

500 S VIRGIL AVE STE 200
LOS ANGELES CA
90020-1446
US

V. Phone/Fax

Practice location:
  • Phone: 213-387-8000
  • Fax: 213-769-5004
Mailing address:
  • Phone: 213-387-8000
  • Fax: 213-387-7387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVE SEEKOOK PARK
Title or Position: OWNER
Credential: M.D.
Phone: 213-387-8000