MEDICARE: AXIS SURGERY CENTER, PC

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

General Provider Information

NPI Number	:	1366394108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AXIS SURGERY CENTER, PC

Provider Business Mailing Address
First Line	:	5832 BEACH BLVD UNIT 210
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90621-5501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 S VIRGIL AVE STE 206
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1443
Country	:	US
Telephone Number	:	213-622-0021
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PHILLIP LIM
Credential	:	DO
Telephone Number	:	213-622-0021

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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