MEDICARE: SAMUEL R WOSK M.D.

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	207R00000X	Internal Medicine Physician	A56374	CA

General Provider Information

NPI Number	:	1689604951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL R WOSK M.D.

Provider Business Mailing Address
First Line	:	5352 POLIS DR
Second Line	:
City	:	LA PALMA
State	:	CA
Zip	:	90623-1787
Country	:	US
Telephone Number	:	714-228-9037
Fax Number	:

Provider Business Practice Location Address
First Line	:	3412 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-1708
Country	:	US
Telephone Number	:	323-264-4006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/08/2007

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