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General NPI Number Information
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NPI Number | 1407201676
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Entity Type | Organization
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Legal Business Name | CANAAN SURGERY CENTER, INC.
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Dates
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Enumeration Date | 04/25/2016
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Last Update Date | 04/25/2016
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Provider Practice Location Address
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Address Line | 903 CRENSHAW BLVD SUITE 200
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City | LOS ANGELES
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State | CA
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Zip | 90019-1964
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Country | US
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Telephone | 323-909-6644
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Fax |
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Provider Business Mailing Address
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Address Line | 903 CRENSHAW BLVD SUITE 200
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City | LOS ANGELES
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State | CA
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Zip | 90019-1964
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Country | US
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Telephone | 323-909-6644
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Fax |
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Authorized Official
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Title or Position | CEO/MEDICAL DIRECTOR
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Name | DR. WALTER JUNG KIM
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Credential | M.D.
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Telephone | 323-909-6644
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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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