Innovative Surgery Center LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

A90876 Issued in CA

Legal business name

INNOVATIVE SURGERY CENTER LLC

Practice address

6610 Flanders Dr
Suite 100
San Diego, CA 92121-3940

Phone

(858) 457-2888

NPI assigned

May 23, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Khang Thai Nguyen, MDNPI 1265590897

Title

President

Phone

(858) 457-2888

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Innovative Surgery Center LLCCCN 05C0002098

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

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

• Khang Thai Nguyen, MD

  • Plastic Surgery Physician
  • Del Mar, CA
  • NPI 1265590897
  NPD (past) Authorized official

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

{
    "created_epoch": "1400803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437436800000",
    "number": "1740692730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6610 FLANDERS DR",
            "address_2": "SUITE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921213940",
            "telephone_number": "858-457-2888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6610 FLANDERS DR",
            "address_2": "SUITE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921213940",
            "telephone_number": "858-457-2888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-23",
        "last_updated": "2015-07-21",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "KHANG",
        "authorized_official_middle_name": "THAI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-457-2888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "CA",
            "license": "A90876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Innova Home Health Inc
• Innova Hospice Inc.
• Innovations Academy
• Innovative Physical Therapy Inc
• Innovative Plastic & Cosmetic Surgery Inc
• Innovative Ultrasound Imaging, Inc.
• Heather Inns
• John Paul Inocentes
• Inocras Inc
• Susan D Inot-Simpson, CNM

• Multi-Specialty Clinic/Center in San Diego, CA
• Providers in San Diego, CA by specialty
• Multi-Specialty Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.