NPIMap

Organization Active NPI

Medwise Medical Clinic, Inc

  • General Practice Physician
  • Glendale, CA
National Provider Identifier
1609813096
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
A42072 Issued in CA
Legal business name
MEDWISE MEDICAL CLINIC, INC
Practice address
540 N Central Ave
Suite 203
Glendale, CA 91203-1916
Phone
(818) 242-0500
NPI assigned
Jun 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Shaliman Eivazzadeh, M.D.
Title
Owner
Phone
(818) 242-0500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X A42072 CA Primary

Addresses

Primary practice location

540 N Central Ave
Suite 203
Glendale, CA 91203-1916

Mailing address

PO Box 601
Glendale, CA 91209-0601
Phone (818) 242-0500

Other identifiers 1

IdentifierTypeStateIssuer
00A420721MedicaidCA

Other names 1

  • MEDWISE MEDICAL CLINIC Former legal business name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609813096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912090601",
            "telephone_number": "818-242-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 N CENTRAL AVE",
            "address_2": "SUITE 203",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912031916",
            "telephone_number": "818-242-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDWISE MEDICAL CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EIVAZZADEH",
        "authorized_official_first_name": "SHALIMAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-242-0500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "A42072",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A420721",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDWISE MEDICAL CLINIC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Glendale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.