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General NPI Number Information
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NPI Number | 1700910262
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA SURGICAL SPECIALISTS, INC.
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 09/03/2009
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Provider Practice Location Address
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Address Line | 1044 S FAIR OAKS AVE SUITE 301
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City | PASADENA
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State | CA
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Zip | 91105-2622
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Country | US
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Telephone | 626-795-9023
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Fax | 626-797-1731
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Provider Business Mailing Address
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Address Line | 1044 SOUTH FAIR OAKS AVE SUITE 301
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City | PASADENA
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State | CA
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Zip | 91105-2622
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Country | US
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Telephone | 626-795-9023
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Fax | 626-797-1731
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | VALERIE KWAN
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Credential |
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Telephone | 310-360-3922
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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 | A62828
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License Number State | CA
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