Chad Wilde MD, a Medical Corporation

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

A96633 Issued in CA

Legal business name

CHAD WILDE MD, A MEDICAL CORPORATION

Practice address

1350 E Los Angeles Ave
Suite 3 a
Simi Valley, CA 93065-2898

Phone

(805) 504-4810

NPI assigned

Dec 21, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Chad Wilde, MD, MS

Title

President

Phone

(805) 504-4810

Specialties & licenses 1

Addresses

Other names 1

• Simi Pain Center Doing business as

Locations

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

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284076800000",
    "number": "1124182001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 E LOS ANGELES AVE",
            "address_2": "SUITE 3 A",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930652898",
            "telephone_number": "805-504-4810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 E LOS ANGELES AVE",
            "address_2": "SUITE 3 A",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930652898",
            "telephone_number": "805-504-4810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAD WILDE MD, A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2010-09-10",
        "status": "A",
        "authorized_official_last_name": "WILDE",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-504-4810",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, MS"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "CA",
            "license": "A96633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Simi Pain Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pain Medicine (Anesthesiology) Physician in Simi Valley, CA
• Providers in Simi Valley, CA by specialty
• Pain Medicine (Anesthesiology) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2010; 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.