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General NPI Number Information
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NPI Number | 1588678445
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Entity Type | Organization
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Legal Business Name | UNIVERSAL FOOT AND ANKLE CLINIC
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 01/21/2008
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Provider Practice Location Address
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Address Line | 3130 W OLYMPIC BLVD SUITE 170
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City | LOS ANGELES
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State | CA
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Zip | 90006-2484
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Country | US
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Telephone | 323-732-7551
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Fax | 323-732-7829
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Provider Business Mailing Address
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Address Line | 3130 W OLYMPIC BLVD SUITE 170
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City | LOS ANGELES
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State | CA
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Zip | 90006-2484
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Country | US
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Telephone | 323-732-7551
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Fax | 323-732-7829
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN SIM
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Credential | D.P.M.
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Telephone | 323-732-7551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E4172
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License Number State | CA
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