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General NPI Number Information
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NPI Number | 1053612853
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Entity Type | Organization
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Legal Business Name | VIP SURGICARE, LLC
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Dates
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Enumeration Date | 11/10/2010
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Last Update Date | 01/29/2019
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Provider Practice Location Address
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Address Line | 15047 LOS GATOS BLVD. SUITE 150
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City | LOS GATOS
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State | CA
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Zip | 95032
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Country | US
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Telephone | 408-358-7000
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Fax | 408-358-7005
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Provider Business Mailing Address
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Address Line | 15047 LOS GATOS BLVD. SUITE 150
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City | LOS GATOS
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State | CA
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Zip | 95032
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Country | US
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Telephone | 408-358-7000
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Fax | 408-358-7005
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | KIRK ANTHONY CHURUKIAN
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Credential | MD
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Telephone | 408-358-7000
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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 | AAAASF2911
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License Number State | CA
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