Healthcare Provider Details

I. General information

NPI: 1508736620
Provider Name (Legal Business Name): CENTURY SURGICAL INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK E STE 607
LOS ANGELES CA
90067-2009
US

IV. Provider business mailing address

2545 N LA CAPELLA CT
ORANGE CA
92867-1922
US

V. Phone/Fax

Practice location:
  • Phone: 818-855-1507
  • Fax:
Mailing address:
  • Phone: 818-855-1557
  • 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: ASHISH SHAH
Title or Position: CEO
Credential: MD
Phone: 818-855-1507