MEDICARE: HOAG OUTPATIENT CENTERS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1043023658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOAG OUTPATIENT CENTERS, LLC

Provider Business Mailing Address
First Line	:	500 SUPERIOR AVE STE 130
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-3659
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 SUPERIOR AVE STE 130
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-3659
Country	:	US
Telephone Number	:	949-520-7804
Fax Number	:	949-520-7805

Authorized Official
Title or Position	:	DIRECTOR/OFFICER
Name	:	JAY MCKIM
Credential	:
Telephone Number	:	949-680-3443

Provider Enumeration Date	:	01/28/2025
Last Update Date	:	01/28/2025

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