Healthcare Provider Details

I. General information

NPI: 1952929580
Provider Name (Legal Business Name): HUNTINGTON COLORECTAL SURGEONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 01/17/2021
Certification Date: 01/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

686 S FAIR OAKS AVE
PASADENA CA
91105-2616
US

IV. Provider business mailing address

686 S FAIR OAKS AVE
PASADENA CA
91105-2616
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-5896
  • Fax: 626-397-5899
Mailing address:
  • Phone: 626-397-5896
  • Fax: 626-397-5899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: HOWARD SCOTT KAUFMAN
Title or Position: OWNER 50/50
Credential: MD
Phone: 626-397-5896