So. Cal. Endo Surgical Medical Group, Inc.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

G59257 Issued in CA

Legal business name

SO. CAL. ENDO SURGICAL MEDICAL GROUP, INC.

Practice address

3838 Sherman Dr Ste 6
Riverside, CA 92503-4001

Phone

(951) 231-2402

Fax

(951) 688-8451

NPI assigned

Sep 11, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amos W Kuvhenguhwa, MD

Title

Owner

Phone

(951) 231-2402

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189468800000",
    "number": "1437344538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1551",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925021551",
            "telephone_number": "951-231-2402",
            "fax_number": "951-688-8451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3838 SHERMAN DR STE 6",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925034001",
            "telephone_number": "951-231-2402",
            "fax_number": "951-688-8451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SO. CAL. ENDO SURGICAL MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-11",
        "last_updated": "2007-09-11",
        "status": "A",
        "authorized_official_last_name": "KUVHENGUHWA",
        "authorized_official_first_name": "AMOS",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "951-231-2402",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "CA",
            "license": "G59257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgery Physician in Riverside, CA
• Providers in Riverside, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.