Provider Demographics
NPI:1629111430
Name:MONTEREY PARK OUTPATIENT SURGERY CENTER INC
Entity Type:Organization
Organization Name:MONTEREY PARK OUTPATIENT SURGERY CENTER INC
Other - Org Name:MONTEREY PARK OUTPATIENT SURGERY CENTER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:QUON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-280-3393
Mailing Address - Street 1:201 W GARVEY AVE
Mailing Address - Street 2:STE. 201
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-7418
Mailing Address - Country:US
Mailing Address - Phone:626-280-3393
Mailing Address - Fax:626-280-2931
Practice Address - Street 1:201 W GARVEY AVE
Practice Address - Street 2:STE. 201
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-7418
Practice Address - Country:US
Practice Address - Phone:626-280-3393
Practice Address - Fax:626-280-2931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000988261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01611FMedicaid
CAS051611Medicare ID - Type UnspecifiedMEDICARE PROVIDER #