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General NPI Number Information
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NPI Number | 1891067864
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Entity Type | Organization
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Legal Business Name | VALLEY LAPAROSCOPIC SURGICAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 02/06/2012
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 2083 COMPTON AVE STE 104
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City | CORONA
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State | CA
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Zip | 92881
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Country | US
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Telephone | 951-719-5904
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 891480
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City | TEMECULA
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State | CA
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Zip | 92589-1480
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Country | US
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Telephone | 951-256-8191
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Fax | 951-256-8190
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID YONGSUK SUH
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Credential | M.D.
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Telephone | 951-256-8191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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