MEDICARE: CENTRAL ENDOSCOPY CENTER

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	:	1588867170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL ENDOSCOPY CENTER

Provider Business Mailing Address
First Line	:	2344 EL CAMINO REAL STE 101
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95050-4072
Country	:	US
Telephone Number	:	408-249-1212
Fax Number	:	408-249-4603

Provider Business Practice Location Address
First Line	:	2344 EL CAMINO REAL STE 101
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95050-4072
Country	:	US
Telephone Number	:	408-249-1212
Fax Number	:	408-249-4603

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	KISUK CHO
Credential	:	MD
Telephone Number	:	408-249-1212

Provider Enumeration Date	:	06/09/2007
Last Update Date	:	09/28/2010

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Directions to “CENTRAL ENDOSCOPY CENTER ” Practice Location

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