Healthcare Provider Details

I. General information

NPI: 1699014852
Provider Name (Legal Business Name): DK SURGERY CENTER, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 W 3RD ST SUITE 102
LOS ANGELES CA
90020-3450
US

IV. Provider business mailing address

4220 W 3RD ST SUITE 102
LOS ANGELES CA
90020-3450
US

V. Phone/Fax

Practice location:
  • Phone: 213-384-4800
  • Fax: 213-384-4811
Mailing address:
  • Phone: 213-384-4800
  • Fax: 213-384-4811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number4512
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID K KAHNG
Title or Position: CEO
Credential: MD
Phone: 213-384-4800