Healthcare Provider Details

I. General information

NPI: 1922840891
Provider Name (Legal Business Name): BSN SURGICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 SEPULVEDA BLVD STE 550
SHERMAN OAKS CA
91411-2587
US

IV. Provider business mailing address

5805 SEPULVEDA BLVD STE 550
SHERMAN OAKS CA
91411-2587
US

V. Phone/Fax

Practice location:
  • Phone: 818-900-6481
  • Fax:
Mailing address:
  • Phone: 818-900-6481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. BABAK EGHBALIEH
Title or Position: CFO
Credential: MD
Phone: 818-900-6481