MEDICARE: BEVERLY HILLS SURGICAL INSTITUTE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	A82791	CA

General Provider Information

NPI Number	:	1235500380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEVERLY HILLS SURGICAL INSTITUTE INC

Provider Business Mailing Address
First Line	:	436 N ROXBURY DR STE 117
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-5016
Country	:	US
Telephone Number	:	310-385-9623
Fax Number	:	310-913-8450

Provider Business Practice Location Address
First Line	:	438 E KATELLA AVE
Second Line	:	D
City	:	ORANGE
State	:	CA
Zip	:	92867-4839
Country	:	US
Telephone Number	:	424-202-0325
Fax Number	:	310-385-8450

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. VISHAL KAPOOR
Credential	:	M.D.
Telephone Number	:	310-913-1735

Provider Enumeration Date	:	10/15/2015
Last Update Date	:	10/15/2015

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