NPIMap

Organization Active NPI

Simi Valley Anesthesia Medical Group

  • Anesthesiology Physician
  • Simi Valley, CA
National Provider Identifier
1912936709
Registry record updated Oct 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
SIMI VALLEY ANESTHESIA MEDICAL GROUP
Practice address
2975 Sycamore Dr
Simi Valley, CA 93065-1201
Phone
(310) 792-3914
Fax
(855) 898-4055
NPI assigned
Jul 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2016

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

Authorized official

Name
Kyo Yong Chu, M.D.NPI 1982618088
Title
Managing Partner
Phone
(310) 792-3914

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

2975 Sycamore Dr
Simi Valley, CA 93065-1201

Mailing address

PO Box 80598
City of Industry, CA 91716-8409
Phone (310) 792-3914

Other identifiers 2

IdentifierTypeStateIssuer
GR0089730MedicaidCA
ZZZ01551ZOtherCABLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050523000866 CA Part B Supplier - Clinic/Group Practice 2062454804 Receives reassigned benefits from 37 practitioners
Practice locations: Simi Valley, CA; Thousand Oaks, CA

National Provider Directory

National Provider Directory

Locations

5353 Balboa Blvd
Ste 0
Encino, CA 91316

550 Saint Charles Dr
Ste 101
Thousand Oaks, CA 91360
Phone (805) 557-7050

Practitioners & affiliated clinicians

Practitioners 46

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

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476921600000",
    "number": "1912936709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80598",
            "city": "CITY OF INDUSTRY",
            "state": "CA",
            "postal_code": "917168409",
            "telephone_number": "310-792-3914",
            "fax_number": "855-898-4055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2975 SYCAMORE DR",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930651201",
            "telephone_number": "310-792-3914",
            "fax_number": "855-898-4055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIMI VALLEY ANESTHESIA MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "last_updated": "2016-10-20",
        "status": "A",
        "authorized_official_last_name": "CHU",
        "authorized_official_first_name": "KYO",
        "authorized_official_middle_name": "YONG",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "310-792-3914",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0089730",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ01551Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Simi Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.