Healthcare Provider Details

I. General information

NPI: 1962999102
Provider Name (Legal Business Name): BEVERLY WILSHIRE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 WILSHIRE BLVD STE 420
BEVERLY HILLS CA
90211-1953
US

IV. Provider business mailing address

8929 WILSHIRE BLVD STE 420
BEVERLY HILLS CA
90211-1953
US

V. Phone/Fax

Practice location:
  • Phone: 310-878-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DENNIS DASS
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 310-878-4800