Healthcare Provider Details

I. General information

NPI: 1073272811
Provider Name (Legal Business Name): EL SEGUNDO ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 E EL SEGUNDO BLVD STE 120
EL SEGUNDO CA
90245-4547
US

IV. Provider business mailing address

23441 MADISON ST STE 220
TORRANCE CA
90505-4756
US

V. Phone/Fax

Practice location:
  • Phone: 310-375-1246
  • Fax:
Mailing address:
  • Phone: 310-375-1246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SUZETTE S. CHAN
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 310-935-5673