Silicon Beach Surgery Center Inc

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SILICON BEACH SURGERY CENTER INC

Practice address

5450 Lincoln Blvd
Playa Vista, CA 90094-2002

Phone

(310) 305-9200

Fax

(310) 305-2800

NPI assigned

Jul 12, 2017

Organization subpart

No

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

Authorized official

Name

Young Sun Yi, MD

Title

Ceo/President

Phone

(310) 305-9200

Specialties & licenses 1

Addresses

Other names 1

• Silicon Beach Surgery Center Inc Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Ambulatory surgical center certification: CCN 05C0002249

Legal name

SILICON BEACH SURGERY CENTER INC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Mar 14, 2019

Last certification

Mar 14, 2019

Ownership / control type

Proprietary

Facility address

5450 Lincoln Blvd
Playa Vista, CA 90094

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1499817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1499817600000",
    "number": "1972025948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13428 MAXELLA AVE # 527",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902925620",
            "telephone_number": "310-305-9200",
            "fax_number": "310-305-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5450 LINCOLN BLVD",
            "city": "PLAYA VISTA",
            "state": "CA",
            "postal_code": "900942002",
            "telephone_number": "310-305-9200",
            "fax_number": "310-305-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SILICON BEACH SURGERY CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-12",
        "last_updated": "2017-07-12",
        "status": "A",
        "authorized_official_last_name": "YI",
        "authorized_official_first_name": "YOUNG",
        "authorized_official_middle_name": "SUN",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "310-305-9200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Silicon Beach Surgery Center Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dominique Robinson
• Runway Optometry a Professional Optometric Corp.
• Sergio Sandoval, OTD, OTR/L
• Rehana Anzai Shah, M.S.W.
• Molly Stephanie Shepherd
• Soheil Levi DDS a Professional Corporation
• Stewart a. Lonky MD, Inc.
• Brittany Ellen Stone, RN
• Audrey Sui
• Tara Nowakhtar OBGYN Medical Corporation

• Ambulatory Surgical Clinic/Center in Playa Vista, CA
• Providers in Playa Vista, 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 Jul 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.