=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821732306
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOAG ORTHOPEDIC INSTITUTE SURGERY CENTER BEVERLY HILLS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2022
-----------------------------------------------------
Last Update Date | 12/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9090 WILSHIRE BLVD STE 102
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90211-1848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-517-3375
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9090 WILSHIRE BLVD STE 102
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90211-1848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-210-8679
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR BUSINESS OPERATIONS
-----------------------------------------------------
Name | TINA NGUYEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 949-517-3375
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------