Provider Demographics
NPI:1023143757
Name:WESTERN FOOT & ANKLE CENTER INC
Entity type:Organization
Organization Name:WESTERN FOOT & ANKLE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:RHEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:323-733-1500
Mailing Address - Street 1:966 S WESTERN AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-1015
Mailing Address - Country:US
Mailing Address - Phone:714-527-3300
Mailing Address - Fax:
Practice Address - Street 1:966 S WESTERN AVE STE 205
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006
Practice Address - Country:US
Practice Address - Phone:323-733-1500
Practice Address - Fax:323-733-1724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3845213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1023143757Medicaid
CAW14001AMedicare PIN