MEDICARE: WILSHIRE JOEUN MEDICAL GROUP, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A54943	CA

General Provider Information

NPI Number	:	1184661316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILSHIRE JOEUN MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	3545 WILSHIRE BLVD
Second Line	:	202
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2354
Country	:	US
Telephone Number	:	213-388-5144
Fax Number	:	213-388-5154

Provider Business Practice Location Address
First Line	:	3545 WILSHIRE BLVD
Second Line	:	202
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2354
Country	:	US
Telephone Number	:	213-388-5144
Fax Number	:	213-388-5154

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDWIN H CHOI
Credential	:	M.D.
Telephone Number	:	213-388-5144

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	08/28/2009

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