Healthcare Provider Details

I. General information

NPI: 1508980400
Provider Name (Legal Business Name): WMG PROCEDURE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4465 WILSHIRE BLVD SUITE #304
LOS ANGELES CA
90010-3704
US

IV. Provider business mailing address

4465 WILSHIRE BLVD SUITE #304
LOS ANGELES CA
90010-3704
US

V. Phone/Fax

Practice location:
  • Phone: 323-938-0060
  • Fax: 323-938-9025
Mailing address:
  • Phone: 323-938-0060
  • Fax: 323-938-9025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number2910287
License Number StateCA

VIII. Authorized Official

Name: HYO-RANG LEE
Title or Position: PRESIDENT
Credential: M.D., PH.D.
Phone: 323-938-0060