Organization Active NPI

Southern California Surgical Specialists, Inc.

  • Surgery Physician
  • Pasadena, CA
National Provider Identifier
1700910262
Registry record updated Sep 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
A62828 Issued in CA
Legal business name
SOUTHERN CALIFORNIA SURGICAL SPECIALISTS, INC.
Practice address
1044 S Fair Oaks Ave
Suite 301
Pasadena, CA 91105-2622
Phone
(626) 795-9023
Fax
(626) 797-1731
NPI assigned
Mar 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2009

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

Authorized official

Name
Valerie Kwan
Title
Billing Manager
Phone
(310) 360-3922

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X A62828 CA Primary

Addresses

Primary practice location

1044 S Fair Oaks Ave
Suite 301
Pasadena, CA 91105-2622

Mailing address

1044 South Fair Oaks Ave
Suite 301
Pasadena, CA 91105-2622
Phone (626) 795-9023

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150325001298 CA Part B Supplier - Clinic/Group Practice 4284726134 Receives reassigned benefits from 1 practitioner
Practice locations: Pasadena, CA

National Provider Directory

National Provider Directory

Locations

1044 S Fair Oaks Ave
Ste 307
Pasadena, CA 91105
Phone (626) 795-9023

1044 S Fair Oaks Ave
Ste 301
Pasadena, CA 91105
Phone (626) 795-9023

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": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251936000000",
    "number": "1700910262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1044 SOUTH FAIR OAKS AVE",
            "address_2": "SUITE 301",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911052622",
            "telephone_number": "626-795-9023",
            "fax_number": "626-797-1731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 S FAIR OAKS AVE",
            "address_2": "SUITE 301",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911052622",
            "telephone_number": "626-795-9023",
            "fax_number": "626-797-1731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA SURGICAL SPECIALISTS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2009-09-03",
        "status": "A",
        "authorized_official_last_name": "KWAN",
        "authorized_official_first_name": "VALERIE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "310-360-3922"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "CA",
            "license": "A62828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2009; 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.