Provider Demographics
NPI:1902906068
Name:WESTERN HEALTH CARE, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:WESTERN HEALTH CARE, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VEASSA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-232-2601
Mailing Address - Street 1:4035 DAVANA RD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-4635
Mailing Address - Country:US
Mailing Address - Phone:323-232-2601
Mailing Address - Fax:
Practice Address - Street 1:4760 S FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-3159
Practice Address - Country:US
Practice Address - Phone:323-232-2601
Practice Address - Fax:323-232-1924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91449Medicare UPIN