=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255538773
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WHITTIER PULMONARY AND CRITICAL CARE MEDICAL GROUP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2007
-----------------------------------------------------
Last Update Date | 07/01/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12462 PUTNAM ST SUITE 208
-----------------------------------------------------
City | WHITTIER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90602-1049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-789-5470
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 511255
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90051-7810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-789-5470
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. NADEEM CHISHTI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 562-789-5470
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | G18915
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------