Healthcare Provider Details

I. General information

NPI: 1639313844
Provider Name (Legal Business Name): HARVARD SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2009
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 SOUTH CRENSHAW BLVD. SUITE 200
LOS ANGELES CA
90019
US

IV. Provider business mailing address

903 SOUTH CRENSHAW BLVD. SUITE 200
LOS ANGELES CA
90019
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 Number930000919
License Number StateCA

VIII. Authorized Official

Name: DR. YONG DAE LEE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 323-937-3333