Healthcare Provider Details

I. General information

NPI: 1881028629
Provider Name (Legal Business Name): MIKO SURGERY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 12/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 N ROXBURY DR SUITE 205B
BEVERLY HILLS CA
90210-5027
US

IV. Provider business mailing address

435 N ROXBURY DR SUITE 205B
BEVERLY HILLS CA
90210-5027
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-2705
  • Fax: 310-275-2701
Mailing address:
  • Phone: 310-275-2705
  • Fax: 310-275-2701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHAEL K OBENG
Title or Position: CEO
Credential: MD
Phone: 310-275-2705