Wilshire Wellness, Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT30229 Issued in CA

Legal business name

WILSHIRE WELLNESS, INC

Practice address

6300 Wilshire Blvd
160
Los Angeles, CA 90048-5204

Phone

(310) 855-9100

Fax

(323) 966-5803

NPI assigned

May 27, 2010

Organization subpart

No

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

Authorized official

Name

Shahin Shaw

Title

Administrator

Phone

(310) 855-9100

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1274918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274918400000",
    "number": "1629397864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6300 WILSHIRE BLVD",
            "address_2": "160",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485204",
            "telephone_number": "310-855-9100",
            "fax_number": "323-966-5803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6300 WILSHIRE BLVD",
            "address_2": "160",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485204",
            "telephone_number": "310-855-9100",
            "fax_number": "323-966-5803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSHIRE WELLNESS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-27",
        "last_updated": "2010-05-27",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "SHAHIN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "310-855-9100"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT30229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Wilshire Westgate Pharmacy
• Wilson C Park Chiropractic Corp
• Wilson H Park, M.D.,Inc.

• Physical Therapist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 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.