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General NPI Number Information
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NPI Number | 1366759904
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Entity Type | Organization
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Legal Business Name | WILSHIRE CARDIOLOGY GROUP, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/02/2010
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 500 S VIRGIL AVE STE. 200
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City | LOS ANGELES
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State | CA
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Zip | 90020-1446
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Country | US
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Telephone | 213-387-8000
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Fax | 213-769-5004
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Provider Business Mailing Address
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Address Line | 500 S VIRGIL AVE STE 200
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City | LOS ANGELES
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State | CA
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Zip | 90020-1446
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Country | US
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Telephone | 213-387-8000
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Fax | 213-387-7387
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Authorized Official
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Title or Position | OWNER
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Name | STEVE SEEKOOK PARK
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Credential | M.D.
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Telephone | 213-387-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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