Healthcare Provider Details

I. General information

NPI: 1275522849
Provider Name (Legal Business Name): COLIMA ENDOSCOPY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S BREA CANYON RD UNIT A
DIAMOND BAR CA
91765-4059
US

IV. Provider business mailing address

1900 S BREA CANYON RD UNIT A
DIAMOND BAR CA
91765-4059
US

V. Phone/Fax

Practice location:
  • Phone: 626-913-1116
  • Fax: 626-913-1261
Mailing address:
  • Phone: 626-913-1116
  • Fax: 626-913-1261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number05C0001387
License Number StateCA

VIII. Authorized Official

Name: MR. SUNG JUN YOO
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 626-913-1116