NPIMap

Organization Active NPI

Mid-Wilshire Health Care Center, Inc

  • Nursing Facility/Intermediate Care Facility
  • Tustin, CA
National Provider Identifier
1336212455
Registry record updated Oct 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
Legal business name
MID-WILSHIRE HEALTH CARE CENTER, INC
Practice address
1051 Bryan Ave
Tustin, CA 92780-4419
Phone
(714) 832-6780
Fax
(714) 832-1031
NPI assigned
Nov 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2009

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

Authorized official

Name
Ms. Jeoung Hie Lee
Title
President
Phone
(323) 934-5660

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X CA Primary

Addresses

Primary practice location

1051 Bryan Ave
Tustin, CA 92780-4419

Mailing address

1101 Crenshaw Blvd
Los Angeles, CA 90019-3112
Phone (323) 934-5660

Other identifiers 1

IdentifierTypeStateIssuer
ZZT11108HMedicaidCA

Other names 1

  • TUSTIN CARE CENTER Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Fidelity Health Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1101 Crenshaw Blvd
Los Angeles, CA 90019

1051 Bryan Ave
Tustin, CA 92780
Phone (714) 532-5797

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255651200000",
    "number": "1336212455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 CRENSHAW BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900193112",
            "telephone_number": "323-934-5660",
            "fax_number": "323-934-0852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 BRYAN AVE",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927804419",
            "telephone_number": "714-832-6780",
            "fax_number": "714-832-1031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-WILSHIRE HEALTH CARE CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2009-10-16",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "JEOUNG",
        "authorized_official_middle_name": "HIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-934-5660",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT11108H",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TUSTIN CARE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tustin, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2009; 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.