Provider Demographics
NPI:1366759904
Name:WILSHIRE CARDIOLOGY GROUP, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:WILSHIRE CARDIOLOGY GROUP, A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE SEEKOOK
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-387-8000
Mailing Address - Street 1:500 S VIRGIL AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1446
Mailing Address - Country:US
Mailing Address - Phone:213-387-8000
Mailing Address - Fax:213-387-7387
Practice Address - Street 1:500 S VIRGIL AVE
Practice Address - Street 2:STE. 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1446
Practice Address - Country:US
Practice Address - Phone:213-387-8000
Practice Address - Fax:213-769-5004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G714481Medicaid
CA2973727OtherMEDICAL PIN
CA060061949OtherRAILROAD MEDICARE
CA060061949OtherRAILROAD MEDICARE
CA00G714481Medicaid