Provider Demographics
NPI:1427101229
Name:WHITTIER ONCOLOGY MEDICAL CLINIC, INC.
Entity type:Organization
Organization Name:WHITTIER ONCOLOGY MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:KUROHARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-696-5964
Mailing Address - Street 1:12393 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90606-2502
Mailing Address - Country:US
Mailing Address - Phone:562-696-5964
Mailing Address - Fax:562-693-6940
Practice Address - Street 1:12393 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-2502
Practice Address - Country:US
Practice Address - Phone:562-696-5964
Practice Address - Fax:562-693-6940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62716261QX0203X
CAG56388261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ72741ZMedicaid
CAZZZ72741ZOtherBLUE SHIELD
CAZZZ72741ZOtherBLUE SHIELD
CAHW343AMedicare ID - Type Unspecified