Healthcare Provider Details

I. General information

NPI: 1073823209
Provider Name (Legal Business Name): BEVERLY HILLS CENTER FOR OUTPATIENT SURGERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 10/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 S LA CIENEGA BLVD SUITE 102
BEVERLY HILLS CA
90211-3328
US

IV. Provider business mailing address

239 S LA CIENEGA BLVD SUITE 102
BEVERLY HILLS CA
90211-3328
US

V. Phone/Fax

Practice location:
  • Phone: 310-553-5315
  • Fax: 310-854-0122
Mailing address:
  • Phone: 310-553-5315
  • Fax: 310-854-0122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number3280188
License Number StateCA

VIII. Authorized Official

Name: DR. STEVE S KIM
Title or Position: CEO
Credential: M.D.,PHD.
Phone: 310-553-5315