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Organization

WILSHIRE MULTI-SPECIALTY CLINIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KUSUM RUDRAPPA MD (MEDICAL DIRECTOR)
(213) 388-3712
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
G87522
CA
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
Primary
A37070
CA

Other

Enumeration date
09/16/2009
Last updated
09/16/2009
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