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General NPI Number Information
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NPI Number | 1003420001
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Entity Type | Organization
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Legal Business Name | ON BEACH SURGERY CENTER, LLC
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Dates
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Enumeration Date | 09/07/2020
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 5832 BEACH BLVD SUITE 210
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City | BUENA PARK
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State | CA
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Zip | 90621
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Country | US
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Telephone | 714-515-5300
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Fax | 714-515-5065
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Provider Business Mailing Address
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Address Line | 5832 BEACH BLVD SUITE 210
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City | BUENA PARK
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State | CA
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Zip | 90621
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Country | US
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Telephone | 714-515-5300
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Fax | 714-515-5065
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Authorized Official
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Title or Position | CEO
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Name | DR. PHILLIP LIM
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Credential | DO
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Telephone | 714-515-5300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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