NPIMap

Organization Active NPI

White Memorial Medical Group, Inc.

  • Internal Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1689769374
Registry record updated Aug 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A42146 Issued in CA
Legal business name
WHITE MEMORIAL MEDICAL GROUP, INC.
Practice address
1701 E Cesar E Chavez Ave
Suite #100
Los Angeles, CA 90033-2464
Phone
(323) 987-1362
Fax
(323) 987-1366
NPI assigned
Oct 4, 2006
Last updated
Aug 10, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2017

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

Authorized official

Name
Dr. Alan C.K. Lau, M.D.NPI 1396768446
Title
President
Phone
(323) 987-1362

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X A42146 CA Primary

Addresses

Primary practice location

1701 E Cesar E Chavez Ave
Suite #100
Los Angeles, CA 90033-2464

Mailing address

PO Box 51741
Los Angeles, CA 90051-6041
Phone (323) 987-1362

Other identifiers 2

IdentifierTypeStateIssuer
GR0015740MedicaidCA
GRE001650MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040206000556 CA Part B Supplier - Clinic/Group Practice 9436042967 Receives reassigned benefits from 14 practitioners
Practice locations: Los Angeles, CA
O20100930065861 CA DME Supplier - Physician - Podiatry 9436042967 Practice locations: Los Angeles, CA

National Provider Directory

National Provider Directory

Locations

1701 E Cesar E Chavez Ave
Ste 10
Los Angeles, CA 90033

1701 E Cesar E Chavez Ave
Ste 100
Los Angeles, CA 90033
Phone (323) 987-1309

1701 E Cesar E Chavez Ave
Ste 51
Los Angeles, CA 90033

414 N Boyle Ave
Ste A
Los Angeles, CA 90033

625 W College St
Ste 201
Los Angeles, CA 90012
Phone (213) 617-8301

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502323200000",
    "number": "1689769374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 51741",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900516041",
            "telephone_number": "323-987-1362",
            "fax_number": "323-987-1366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 E CESAR E CHAVEZ AVE",
            "address_2": "SUITE #100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900332464",
            "telephone_number": "323-987-1362",
            "fax_number": "323-987-1366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE MEMORIAL MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2017-08-10",
        "status": "A",
        "authorized_official_last_name": "LAU",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "C.K.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-987-1362",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A42146",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0015740",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GRE001650",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.