Basic Information
| Provider Information | |||||||||
| NPI: | 1639313844 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARVARD SURGERY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 903 SOUTH CRENSHAW BLVD. | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239373333 | ||||||||
| FaxNumber: | 3239374933 | ||||||||
| Practice Location | |||||||||
| Address1: | 903 SOUTH CRENSHAW BLVD. | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239373333 | ||||||||
| FaxNumber: | 3239374933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2009 | ||||||||
| LastUpdateDate: | 05/01/2009 | ||||||||
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| AuthorizedOfficialLastName: | LEE | ||||||||
| AuthorizedOfficialFirstName: | YONG | ||||||||
| AuthorizedOfficialMiddleName: | DAE | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3239373333 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 930000919 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.