Provider Demographics
NPI:1992194310
Name:ONE WEST MEDICAL GROUP, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ONE WEST MEDICAL GROUP, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOOL-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-553-5203
Mailing Address - Street 1:PO BOX 894874
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90189-4874
Mailing Address - Country:US
Mailing Address - Phone:310-553-5203
Mailing Address - Fax:310-652-0933
Practice Address - Street 1:8920 WILSHIRE BLVD STE 310
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2003
Practice Address - Country:US
Practice Address - Phone:310-553-5203
Practice Address - Fax:310-652-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty