Basic Information
| Provider Information | |||||||||
| NPI: | 1629111430 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONTEREY PARK OUTPATIENT SURGERY CENTER INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MONTEREY PARK OUTPATIENT SURGERY CENTER INC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 W GARVEY AVE | ||||||||
| Address2: | STE. 201 | ||||||||
| City: | MONTEREY PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917547418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262803393 | ||||||||
| FaxNumber: | 6262802931 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 W GARVEY AVE | ||||||||
| Address2: | STE. 201 | ||||||||
| City: | MONTEREY PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917547418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262803393 | ||||||||
| FaxNumber: | 6262802931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 11/13/2014 | ||||||||
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| AuthorizedOfficialLastName: | QUON | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6262803393 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 930000988 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | SUR01611F | 05 | CA | MEDICAID |