Organization Active NPI

Socal Academic Surgical Consultants Inc

  • Surgery Physician
  • Colton, CA
National Provider Identifier
1689550055
Registry record updated Aug 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
SOCAL ACADEMIC SURGICAL CONSULTANTS INC
Practice address
400 N Pepper Ave Ste 308
Colton, CA 92324-1801
Phone
(646) 770-4660
NPI assigned
Aug 12, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2025

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

Authorized official

Name
Amir Ali Rahnemai Azar, MD
Title
President
Phone
(646) 770-4660

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

400 N Pepper Ave Ste 308
Colton, CA 92324-1801

Mailing address

PO Box 123
Pasadena, CA 91102-0123

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260206003269 CA Part B Supplier - Clinic/Group Practice 4587168521 Receives reassigned benefits from 1 practitioner
Practice locations: San Bernardino, CA; Los Angeles, CA; Glendale, CA; Burbank, CA

National Provider Directory

National Provider Directory

Locations

1805 Medical Center Dr
Sn Bernrdno, CA 92411
Phone (909) 877-6333

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1754956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754956800000",
    "number": "1689550055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 123",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911020123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N PEPPER AVE STE 308",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923241801",
            "telephone_number": "646-770-4660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOCAL ACADEMIC SURGICAL CONSULTANTS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-12",
        "last_updated": "2025-08-12",
        "certification_date": "2025-08-11",
        "status": "A",
        "authorized_official_last_name": "AZAR",
        "authorized_official_first_name": "AMIR ALI",
        "authorized_official_middle_name": "RAHNEMAI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "646-770-4660",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.