The Surgery Center on Sand Canyon Shady Canyon Exit

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

THE SURGERY CENTER ON SAND CANYON SHADY CANYON EXIT

Practice address

16300 Sand Canyon Ave
Suite 901
Irvine, CA 92618-3711

Phone

(949) 677-9695

Fax

(949) 453-8601

NPI assigned

Jan 5, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Albert Beomjin Chang, M.D.

Title

Medical Director

Phone

(949) 585-9870

Specialties & licenses 1

Addresses

Other names 1

• The Surgery Center on Sand Canyon Shady Canyon Exit Former legal business name

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

{
    "created_epoch": "1294185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294185600000",
    "number": "1851695860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16300 SAND CANYON AVE",
            "address_2": "SUITE 901",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926183711",
            "telephone_number": "949-677-9695",
            "fax_number": "949-453-8601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16300 SAND CANYON AVE",
            "address_2": "SUITE 901",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926183711",
            "telephone_number": "949-677-9695",
            "fax_number": "949-453-8601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SURGERY CENTER ON SAND CANYON SHADY CANYON EXIT",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-05",
        "last_updated": "2011-01-05",
        "status": "A",
        "authorized_official_last_name": "CHANG",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_middle_name": "BEOMJIN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "949-585-9870",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Surgery Center on Sand Canyon Shady Canyon Exit",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2011; 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.