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General NPI Number Information
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NPI Number | 1548609472
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Entity Type | Organization
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Legal Business Name | KINETIX SURGERY CENTER, INC
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Dates
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Enumeration Date | 06/25/2013
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Last Update Date | 06/25/2013
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Provider Practice Location Address
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Address Line | 5651 SEPULVEDA BLVD SUITE 101
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City | SHERMAN OAKS
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State | CA
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Zip | 91411-2916
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Country | US
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Telephone | 818-788-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 5651 SEPULVEDA BLVD SUITE 101
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City | SHERMAN OAKS
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State | CA
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Zip | 91411-2916
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Country | US
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Telephone | 818-788-2400
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Fax |
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | DR. EDWIN HARONIAN
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Credential | M.D.
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Telephone | 818-205-9388
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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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