NPIMap

Organization Active NPI

Blue Wave Surgical Center, Inc.

  • Family Medicine Physician
  • Lomita, CA
National Provider Identifier
1770840100
Registry record updated Apr 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A54193 Issued in CA
Legal business name
BLUE WAVE SURGICAL CENTER, INC.
Practice address
25043 Narbonne Ave # a
Lomita, CA 90717-2101
Phone
(818) 986-9918
NPI assigned
Apr 23, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2012

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

Authorized official

Name
Dr. Alexander Sorokurs, M.D.
Title
President
Phone
(310) 622-5369

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X A54193 CA Primary

Addresses

Primary practice location

25043 Narbonne Ave # a
Lomita, CA 90717-2101

Mailing address

4910 Van Nuys Blvd Ste 306
Sherman Oaks, CA 91403-1770
Phone (818) 986-9918

National Provider Directory

National Provider Directory
Tax ID family
Blue Wave Surgery Center Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

25043 Narbonne Ave
#A
Lomita, CA 90717
Phone (424) 203-8990

NPI Registry JSON

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

{
    "created_epoch": "1335139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335139200000",
    "number": "1770840100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4910 VAN NUYS BLVD STE 306",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "914031770",
            "telephone_number": "818-986-9918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25043 NARBONNE AVE # A",
            "city": "LOMITA",
            "state": "CA",
            "postal_code": "907172101",
            "telephone_number": "818-986-9918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WAVE SURGICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-23",
        "last_updated": "2012-04-23",
        "status": "A",
        "authorized_official_last_name": "SOROKURS",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-622-5369",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A54193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lomita, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2012; 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.