Healthcare Provider Details

I. General information

NPI: 1164723284
Provider Name (Legal Business Name): SURF CITY PEDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 11/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17742 BEACH BLVD SUITE 240
HUNTINGTON BEACH CA
92647-6818
US

IV. Provider business mailing address

17742 BEACH BLVD SUITE 240
HUNTINGTON BEACH CA
92647-6818
US

V. Phone/Fax

Practice location:
  • Phone: 714-842-0444
  • Fax: 714-842-8444
Mailing address:
  • Phone: 714-842-0444
  • Fax: 714-842-8444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAULINE LIANG PEPEK
Title or Position: OWNER
Credential: M.D
Phone: 714-842-0444