Healthcare Provider Details

I. General information

NPI: 1649774977
Provider Name (Legal Business Name): VANGUARD SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 WILSHIRE BLVD STE 100
BEVERLY HILLS CA
90210-6100
US

IV. Provider business mailing address

9301 WILSHIRE BLVD STE 100
BEVERLY HILLS CA
90210-6100
US

V. Phone/Fax

Practice location:
  • Phone: 310-855-3960
  • Fax:
Mailing address:
  • Phone: 310-855-3960
  • 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: DR. PERRY LIU
Title or Position: CHAIRMAN, GOVERNING BODY
Credential: M.D.
Phone: 310-855-3960