Healthcare Provider Details

I. General information

NPI: 1437147485
Provider Name (Legal Business Name): ASSOCIATED SURGEONS OF SAN LUIS OBISPO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 OAK PARK BLVD STE 201
PISMO BEACH CA
93449-3400
US

IV. Provider business mailing address

921 OAK PARK BLVD STE 201
PISMO BEACH CA
93449-3400
US

V. Phone/Fax

Practice location:
  • Phone: 805-546-0411
  • Fax: 805-473-4891
Mailing address:
  • Phone: 805-546-0411
  • Fax: 805-473-4891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. EDWIN SUEYO HAYASHI
Title or Position: GENERAL PARTNER
Credential: MD FACS
Phone: 805-546-0411