NPIMap

Organization Active NPI

Kintsugi Surgical, LLC

Doing business as Robotics Outpatient Center Los Angeles

  • Ambulatory Surgical Clinic/Center
  • Los Angeles, CA
National Provider Identifier
1912506601
Registry record updated Jul 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
KINTSUGI SURGICAL, LLC
Doing business as
Robotics Outpatient Center Los Angeles
Practice address
1127 Wilshire Blvd Ste 1000
Los Angeles, CA 90017-4001
Phone
(213) 328-3600
Fax
(213) 395-0683
NPI assigned
Oct 22, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2021

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

Authorized official

Name
Derek Tan Dee, MD
Title
Medical Director
Phone
(213) 328-3600

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

1127 Wilshire Blvd Ste 1000
Los Angeles, CA 90017-4001

Mailing address

1127 Wilshire Blvd Ste 1000
Los Angeles, CA 90017-4001
Phone (213) 328-3600

Other names 1

  • ROBOTICS OUTPATIENT CENTER LOS ANGELES Doing business as

National Provider Directory

National Provider Directory

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": "1603324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627344000000",
    "number": "1912506601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1127 WILSHIRE BLVD STE 1000",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900174001",
            "telephone_number": "213-328-3600",
            "fax_number": "213-395-0683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1127 WILSHIRE BLVD STE 1000",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900174001",
            "telephone_number": "213-328-3600",
            "fax_number": "213-395-0683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINTSUGI SURGICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-22",
        "last_updated": "2021-07-27",
        "certification_date": "2021-07-27",
        "status": "A",
        "authorized_official_last_name": "DEE",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "TAN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "213-328-3600",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ROBOTICS OUTPATIENT CENTER LOS ANGELES",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ROBOTICS OUTPATIENT CENTER LOS ANGELES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2021; 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.