Wilshire Multi-Specialty Clinic

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

A37070 Issued in CA

Legal business name

WILSHIRE MULTI-SPECIALTY CLINIC

Practice address

3540 Wilshire Blvd
Ste: 1028
Los Angeles, CA 90010-2307

Phone

(213) 388-3712

Fax

(213) 388-0734

NPI assigned

Sep 16, 2009

Organization subpart

No

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

Authorized official

Name

Kusum Rudrappa, MD

Title

Medical Director

Phone

(213) 388-3712

Specialties & licenses 7

Addresses

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

{
    "created_epoch": "1253059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253059200000",
    "number": "1487987905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3540 WILSHIRE BLVD",
            "address_2": "STE: 1028",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900102307",
            "telephone_number": "213-388-3712",
            "fax_number": "213-388-0734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3540 WILSHIRE BLVD",
            "address_2": "STE: 1028",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900102307",
            "telephone_number": "213-388-3712",
            "fax_number": "213-388-0734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSHIRE MULTI-SPECIALTY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-16",
        "last_updated": "2009-09-16",
        "status": "A",
        "authorized_official_last_name": "RUDRAPPA",
        "authorized_official_first_name": "KUSUM",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "213-388-3712",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "G87522",
            "primary": false
        },
        {
            "code": "207QS1201X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sports Medicine",
            "state": "CA",
            "license": "A37070",
            "primary": false
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "CA",
            "license": "A54260",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "G36302",
            "primary": false
        },
        {
            "code": "2084P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Pain Medicine",
            "state": "CA",
            "license": "PSY12331",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "A37070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wilshire Home Health, Inc.
• Wilshire Imaging Group, Inc
• Wilshire Joeun Medical Group, Inc
• Wilshire la Jolla Pharmacy Inc
• Wilshire Medical Clinic
• Wilshire Optometry Inc.
• Wilshire Oral Surgery & Implant Center
• Wilshire Orthopaedic and Medical Associates Inc
• Wilshire Radiology
• Wilshire Radiology MRI Inc

• General Practice Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• General Practice Physician in California

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