Healthcare Provider Details

I. General information

NPI: 1386003390
Provider Name (Legal Business Name): RIVERWALK SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 RIVERWALK PKWY SUITE 140
RIVERSIDE CA
92505-8510
US

IV. Provider business mailing address

4234 RIVERWALK PKWY SUITE 140
RIVERSIDE CA
92505-8510
US

V. Phone/Fax

Practice location:
  • Phone: 951-509-9204
  • Fax: 951-509-9206
Mailing address:
  • Phone: 951-509-9204
  • Fax: 951-509-9206

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: DR. JOSEPH K. KU
Title or Position: CHAIRMAN, GOVERNING BODY
Credential: M.D.
Phone: 951-509-9204