Blue Wave Surgery Center, Inc.

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

A54193 Issued in CA

Legal business name

BLUE WAVE SURGERY CENTER, INC.

Practice address

4910 Van Nuys Blvd Ste 306
Sherman Oaks, CA 91403-1770

Phone

(310) 622-5369

NPI assigned

Feb 29, 2012

Organization subpart

Yes

Parent organization

BLUE WAVE SURGERY CENTER, INCAs reported in NPPES

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 2

Addresses

Tax ID family

Blue Wave Surgery Center Inc2 organizations share this tax ID, including this one

Part of

Blue Wave Surgery Center Inc

Other organizations with this tax ID 1

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

• Blue Wave Surgical Center, Inc.

  • Family Medicine Physician
  • Lomita, CA
  • NPI 1770840100
  NPD tax ID

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

{
    "created_epoch": "1330473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334620800000",
    "number": "1821362443",
    "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": "310-622-5369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4910 VAN NUYS BLVD STE 306",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "914031770",
            "telephone_number": "310-622-5369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WAVE SURGERY CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BLUE WAVE SURGERY CENTER, INC",
        "enumeration_date": "2012-02-29",
        "last_updated": "2012-04-17",
        "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": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "A54193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Miranda Boe, PSYD
• Eric Boehme, DPT
• Megan Elizabeth Boen

• Ambulatory Surgical Clinic/Center in Sherman Oaks, CA
• Providers in Sherman Oaks, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 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.