Healthcare Provider Details

I. General information

NPI: 1609417930
Provider Name (Legal Business Name): BK SURGICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41870 GARSTIN DRIVE
BIG BEAR LAKE CA
92315-1649
US

IV. Provider business mailing address

5400 KODIAK MOUNTAIN DR
YORBA LINDA CA
92887-4258
US

V. Phone/Fax

Practice location:
  • Phone: 913-209-4619
  • Fax:
Mailing address:
  • Phone: 913-209-4619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BHANI KAUR CHAWLA KONDAL
Title or Position: CEO
Credential: MD
Phone: 913-209-4619