# WILSHIRE DISTRICT MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447363692
- **Authorized official:** DR. SIMON JIANG M.D. (CEO)
- **Authorized official phone:** (213) 384-5132

## Contact information

- **Practice address:** 1314 WILSHIRE BLVD., LOS ANGELES, CA 90017-1705
- **Practice address phone:** (213) 384-5132
- **Practice address fax:** (213) 234-4542
- **Mailing address:** 13521 TELEGRAPH RD STE B, WHITTIER, CA 90605-3462
- **Mailing address phone:** (562) 946-7571
- **Mailing address fax:** (213) 234-4542

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | A69991 | CA | — |
| 208D00000X | General Practice Physician | A69991 | CA | Yes |

## Other

- **Enumeration date:** 08/15/2006
- **Last updated:** 10/03/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00A699910 | — | CA |