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General NPI Number Information
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NPI Number | 1114894599
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Entity Type | Organization
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Legal Business Name | KLM SURGICAL ASSOCIATES
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Dates
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Enumeration Date | 10/21/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 4640 ADMIRALTY WAY STE 901
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6630
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Country | US
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Telephone | 310-577-5540
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Fax | 310-623-1922
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Provider Business Mailing Address
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Address Line | 4640 ADMIRALTY WAY STE 901
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6630
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Country | US
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Telephone | 310-577-5540
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Fax | 310-623-1922
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Authorized Official
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Title or Position | PARTNER
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Name | DR. SERGEY LYASS
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Credential | MD
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Telephone | 310-402-1782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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