Healthcare Provider Details

I. General information

NPI: 1922828284
Provider Name (Legal Business Name): KECK MEDICINE OF USC SURGERY CENTER, PASADENA - LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 S FAIR OAKS AVE
PASADENA CA
91105-2614
US

IV. Provider business mailing address

590 S FAIR OAKS AVE
PASADENA CA
91105-2614
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-8747
  • Fax:
Mailing address:
  • Phone: 323-442-8747
  • 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: JEREMY CHURCH
Title or Position: CFO/USC CARE MEDICAL GROUP, INC.
Credential:
Phone: 323-442-8747