Mid-Wilshire Health Inc

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

MID-WILSHIRE HEALTH INC

Practice address

1809 Verdugo Blvd Ste 110
Glendale, CA 91208-1402

Phone

(818) 928-1304

NPI assigned

Sep 28, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Samuel Gong, PHARM DNPI 1538638531

Title

Ceo

Phone

(310) 780-0735

Specialties & licenses 1

Addresses

Other names 1

• 986 pharmacy #8007 Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Practitioners 2

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

• Samuel John Gong, PHARM D

  • Pharmacist
  • Glendale, CA
  • NPI 1538638531
  NPD Authorized official
• John Young Gong, PHARM D

  • Pharmacist
  • Glendale, CA
  • NPI 1528537529
  NPD

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

{
    "created_epoch": "1538092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538092800000",
    "number": "1407331002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2106 YOSEMITE DR",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900412702",
            "telephone_number": "310-780-0735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1809 VERDUGO BLVD STE 110",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912081402",
            "telephone_number": "818-928-1304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-WILSHIRE HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-28",
        "last_updated": "2018-09-28",
        "status": "A",
        "authorized_official_last_name": "GONG",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-780-0735",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "986 pharmacy #8007",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Denise Michele, D.C.
• Amy Micheletti
• Brian Michels
• Micrex
• Mid-West Diagnostics, Inc.
• Midas Healing Hospice, Inc
• Denise M Middleton, MS, C.C.C.
• Midpoint Wellness Center
• Siranush Miduryan, PHARMD
• John J. Mielke, O.D.

• Pharmacy in Glendale, CA
• Providers in Glendale, CA by specialty
• Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.