Provider Demographics
NPI:1083056733
Name:SAN DIEGO ANESTHESIA CONSULTING GRP INC
Entity Type:Organization
Organization Name:SAN DIEGO ANESTHESIA CONSULTING GRP INC
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNG
Authorized Official - Middle Name:SOO
Authorized Official - Last Name:YI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-460-5113
Mailing Address - Street 1:PO BOX 997
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91944-0997
Mailing Address - Country:US
Mailing Address - Phone:619-460-5113
Mailing Address - Fax:619-460-7815
Practice Address - Street 1:5555 GROSSMONT CENTER DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3019
Practice Address - Country:US
Practice Address - Phone:619-140-0711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104441174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty