Provider Demographics
NPI:1699382523
Name:BEVERLY HILLS OUTPATIENT SURGERY CENTER INC
Entity Type:Organization
Organization Name:BEVERLY HILLS OUTPATIENT SURGERY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PUNEET
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:CHANDAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-595-8687
Mailing Address - Street 1:39120 ARGONAUT WAY # 827
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1304
Mailing Address - Country:US
Mailing Address - Phone:510-715-9449
Mailing Address - Fax:
Practice Address - Street 1:50 N LA CIENEGA BLVD STE 203
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2246
Practice Address - Country:US
Practice Address - Phone:510-364-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA79514Medicaid