Provider Demographics
NPI:1407357601
Name:STAR AMBULATORY SURGERY CENTER, INC.
Entity Type:Organization
Organization Name:STAR AMBULATORY SURGERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YONG
Authorized Official - Middle Name:TAI
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-731-0681
Mailing Address - Street 1:903 CRENSHAW BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-1966
Mailing Address - Country:US
Mailing Address - Phone:323-937-3333
Mailing Address - Fax:323-937-4933
Practice Address - Street 1:903 CRENSHAW BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-1966
Practice Address - Country:US
Practice Address - Phone:323-937-3333
Practice Address - Fax:323-937-4933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-22
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty