# COUNTY OF LOS ANGELES AUDITOR CONTROLLER

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MLK-AMBULATORY SURGICAL CENTER-RADIOLOGY
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1649452988
- **Legal business name:** MLK-AMBULATORY SURGICAL CENTER-RADIOLOGY
- **Authorized official:** FREDERICK RUTHERFORD DDS (ASSOC MEDICAL DIRECTOR)
- **Authorized official phone:** (310) 668-4501

## Contact information

- **Practice address:** 12021 WILMINGTON AVE, LOS ANGELES, CA 90059-3019
- **Practice address phone:** (310) 668-4501
- **Practice address fax:** (310) 763-8909
- **Mailing address:** 12021 WILMINGTON AVE, LOS ANGELES, CA 90059-3019
- **Mailing address phone:** (310) 668-4501
- **Mailing address fax:** (310) 763-8909

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | CA | Yes |

## Other

- **Enumeration date:** 11/28/2007
- **Last updated:** 11/28/2007