Healthcare Provider Details

I. General information

NPI: 1497512883
Provider Name (Legal Business Name): HAAS SPECIALTY SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E BROADWAY STE 100
GLENDALE CA
91205-1383
US

IV. Provider business mailing address

1101 E BROADWAY STE 100
GLENDALE CA
91205-1383
US

V. Phone/Fax

Practice location:
  • Phone: 818-500-9286
  • Fax:
Mailing address:
  • Phone:
  • 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: DR. STEPAN KASIMIAN
Title or Position: CHAIRMAN, GOVERNING BODY
Credential: MD
Phone: 818-409-8000