# WILSHIRE MULTI-SPECIALTY CLINIC

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

## Provider details

- **NPI number:** 1487987905
- **Authorized official:** KUSUM RUDRAPPA MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (213) 388-3712

## Contact information

- **Practice address:** 3540 WILSHIRE BLVD, STE: 1028, LOS ANGELES, CA 90010-2307
- **Practice address phone:** (213) 388-3712
- **Practice address fax:** (213) 388-0734
- **Mailing address:** 3540 WILSHIRE BLVD, STE: 1028, LOS ANGELES, CA 90010-2307
- **Mailing address phone:** (213) 388-3712
- **Mailing address fax:** (213) 388-0734

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | G87522 | CA | — |
| 207QS1201X | Sleep Medicine (Family Medicine) Physician | — | NULL | — |
| 207QS1201X | Sleep Medicine (Family Medicine) Physician | — | — | — |
| 207RS0010X | Sports Medicine (Internal Medicine) Physician | A37070 | CA | — |
| 207RS0012X | Sleep Medicine (Internal Medicine) Physician | A54260 | CA | — |
| 207Y00000X | Otolaryngology Physician | G36302 | CA | — |
| 2084P2900X | Pain Medicine (Psychiatry & Neurology) Physician | PSY12331 | CA | — |
| 208D00000X | General Practice Physician | A37070 | CA | Yes |

## Other

- **Enumeration date:** 09/16/2009
- **Last updated:** 09/16/2009