Provider Demographics
NPI:1164723284
Name:SURF CITY PEDS
Entity Type:Organization
Organization Name:SURF CITY PEDS
Other - Org Name:PAULINE PEPEK, M.D
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:LIANG
Authorized Official - Last Name:PEPEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-842-0444
Mailing Address - Street 1:17742 BEACH BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6818
Mailing Address - Country:US
Mailing Address - Phone:714-842-0444
Mailing Address - Fax:714-842-8444
Practice Address - Street 1:17742 BEACH BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6818
Practice Address - Country:US
Practice Address - Phone:714-842-0444
Practice Address - Fax:714-842-8444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1427086628OtherNPI