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General NPI Number Information
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NPI Number | 1578652152
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Entity Type | Organization
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Legal Business Name | IRVINE SURGICAL MEDICAL GROUP CORP
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 15825 LAGUNA CANYON RD SUITE 100
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City | IRVINE
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State | CA
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Zip | 92618-2125
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Country | US
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Telephone | 949-679-6700
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Fax | 949-387-9530
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Provider Business Mailing Address
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Address Line | 15825 LAGUNA CANYON RD SUITE 100
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City | IRVINE
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State | CA
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Zip | 92618-2125
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Country | US
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Telephone | 949-679-6700
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Fax | 949-387-9530
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Authorized Official
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Title or Position | CHIEF MEDICAL DIRECTOR AND FINANCIA
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Name | ARDALAN BABAKNIA
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Credential | PHD,M.D.
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Telephone | 949-753-8844
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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 | 550000008
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License Number State | CA
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