MEDICARE: SOLIS SURGICAL ARTS CENTER 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	930000888	CA
2	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1669551941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLIS SURGICAL ARTS CENTER INC

Provider Business Mailing Address
First Line	:	5620 WILBUR AVE STE 319
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-1309
Country	:	US
Telephone Number	:	818-344-4210
Fax Number	:	818-344-4093

Provider Business Practice Location Address
First Line	:	5620 WILBUR AVE. SUITE 319
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-1351
Country	:	US
Telephone Number	:	818-344-4210
Fax Number	:	818-344-4093

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	KENNETH KIANFU LEE
Credential	:	DDS
Telephone Number	:	818-344-4210

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	01/20/2025

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