Healthcare Provider Details

I. General information

NPI: 1396656708
Provider Name (Legal Business Name): LA MESA ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7339 EL CAJON BLVD STE JK
LA MESA CA
91942-7435
US

IV. Provider business mailing address

7339 EL CAJON BLVD J/K
LA MESA CA
91942-7435
US

V. Phone/Fax

Practice location:
  • Phone: 800-898-2020
  • 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: TOM CHANG
Title or Position: OWNER
Credential: MD
Phone: 626-269-5348