Healthcare Provider Details

I. General information

NPI: 1407357601
Provider Name (Legal Business Name): STAR AMBULATORY SURGERY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 CRENSHAW BLVD STE 200
LOS ANGELES CA
90019-1966
US

IV. Provider business mailing address

903 CRENSHAW BLVD STE 200
LOS ANGELES CA
90019-1966
US

V. Phone/Fax

Practice location:
  • Phone: 323-937-3333
  • Fax: 323-937-4933
Mailing address:
  • Phone: 323-937-3333
  • Fax: 323-937-4933

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: YONG TAI LEE
Title or Position: CEO
Credential: MD
Phone: 323-731-0681