Wilshire District Medical Group

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

A69991 Issued in CA

Legal business name

WILSHIRE DISTRICT MEDICAL GROUP

Practice address

925 S Atlantic Blvd Ste 106
Monterey Park, CA 91754

Phone

(213) 458-3132

Fax

(213) 234-4542

NPI assigned

Aug 31, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Simon Jiang, M.D.

Title

President

Phone

(213) 458-3132

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527552000000",
    "number": "1104010248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13521 TELEGRAPH RD STE B",
            "city": "WHITTIER",
            "state": "CA",
            "postal_code": "906053462",
            "telephone_number": "562-946-7571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 S ATLANTIC BLVD STE 106",
            "city": "MONTEREY PARK",
            "state": "CA",
            "postal_code": "91754",
            "telephone_number": "213-458-3132",
            "fax_number": "213-234-4542"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13521 Telegraph Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Whittier",
            "state": "CA",
            "postal_code": "906053462",
            "country_code": "US",
            "telephone_number": "562-946-7571",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WILSHIRE DISTRICT MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-31",
        "last_updated": "2018-05-29",
        "status": "A",
        "authorized_official_last_name": "JIANG",
        "authorized_official_first_name": "SIMON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "213-458-3132",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "A69991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A699911",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Monterey Park, CA
• Providers in Monterey Park, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.