Healthcare Provider Details

I. General information

NPI: 1992490452
Provider Name (Legal Business Name): ASSOCIATION OF SOUTH BAY SURGEONS VASCULAR CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23560 MADISON ST STE 110
TORRANCE CA
90505-4709
US

IV. Provider business mailing address

23560 MADISON ST STE 110
TORRANCE CA
90505-4709
US

V. Phone/Fax

Practice location:
  • Phone: 310-373-6864
  • Fax: 310-602-3895
Mailing address:
  • Phone: 310-373-6864
  • Fax: 310-602-3895

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: MR. AMIR KAVIANI
Title or Position: PRESIDENT
Credential: MD
Phone: 310-373-6864