=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275911489
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HSU BEVERLY HILLS SURGERY CENTER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2015
-----------------------------------------------------
Last Update Date | 05/08/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3350 WILSHIRE BLVD 100
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90010-1824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-383-3322
-----------------------------------------------------
Fax | 213-383-1667
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3350 WILSHIRE BLVD 100
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90010-1824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-383-3322
-----------------------------------------------------
Fax | 213-383-1667
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. CHARLES S HSU
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 310-888-2228
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | A84401
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------