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General NPI Number Information
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NPI Number | 1144370594
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Entity Type | Organization
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Legal Business Name | THIRD STREET SURGERY CENTER LLC
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 11/04/2021
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Provider Practice Location Address
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Address Line | 420 E 3RD ST STE 110
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City | LOS ANGELES
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State | CA
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Zip | 90013-1645
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Country | US
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Telephone | 213-617-9194
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Fax |
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Provider Business Mailing Address
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Address Line | 420 E 3RD ST SUITE 110
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City | LOS ANGELES
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State | CA
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Zip | 90013-1644
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Country | US
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Telephone | 213-617-9194
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Fax | 213-617-0605
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Authorized Official
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Title or Position | VICE PRESIDENT/MEDICAL DIRECTOR
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Name | ALEX LIU
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Credential | MD
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Telephone | 213-617-9194
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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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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 930001001
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License Number State | CA
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