Healthcare Provider Details

I. General information

NPI: 1548877590
Provider Name (Legal Business Name): SLEEP APNEA SURGERY CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 UNIVERSITY AVENUE
EAST PALO ALTO CA
94303
US

IV. Provider business mailing address

1900 UNIVERSITY AVENUE
EAST PALO ALTO CA
94303
US

V. Phone/Fax

Practice location:
  • Phone: 650-324-8376
  • Fax: 650-324-8339
Mailing address:
  • Phone: 650-324-8376
  • Fax: 650-324-8339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KASEY K LI
Title or Position: DIRECTOR
Credential: MD
Phone: 650-324-8376