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General NPI Number Information
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NPI Number | 1639720097
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Entity Type | Organization
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Legal Business Name | SERGEY LYASS MD SURGICAL
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Dates
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Enumeration Date | 09/26/2019
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 6404 WILSHIRE BLVD STE 701
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City | LOS ANGELES
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State | CA
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Zip | 90048-5509
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Country | US
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Telephone | 604-623-1786
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Fax | 310-623-1922
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Provider Business Mailing Address
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Address Line | 6404 WILSHIRE BLVD STE 701
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City | LOS ANGELES
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State | CA
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Zip | 90048-5509
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Country | US
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Telephone | 310-623-1786
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Fax | 310-623-1922
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Authorized Official
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Title or Position | PRESIDENT
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Name | SERGEY LYASS
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Credential |
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Telephone | 310-623-1786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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