Healthcare Provider Details

I. General information

NPI: 1336213099
Provider Name (Legal Business Name): SAN GABRIEL AMBULATORY SURGERY CENTER, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 N SANTA ANITA AVE STE 404
ARCADIA CA
91006-3183
US

IV. Provider business mailing address

288 N SANTA ANITA AVE STE 404
ARCADIA CA
91006-3183
US

V. Phone/Fax

Practice location:
  • Phone: 626-300-5300
  • Fax: 626-300-5355
Mailing address:
  • Phone: 626-300-5300
  • Fax: 626-300-5355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number550000023
License Number StateCA

VIII. Authorized Official

Name: TOM CHANG
Title or Position: OWNER
Credential: MD
Phone: 626-676-0838