Healthcare Provider Details

I. General information

NPI: 1891067864
Provider Name (Legal Business Name): VALLEY LAPAROSCOPIC SURGICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2083 COMPTON AVE STE 104
CORONA CA
92881
US

IV. Provider business mailing address

PO BOX 891480
TEMECULA CA
92589-1480
US

V. Phone/Fax

Practice location:
  • Phone: 951-719-5904
  • Fax:
Mailing address:
  • Phone: 951-256-8191
  • Fax: 951-256-8190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID YONGSUK SUH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 951-256-8191