Provider Demographics
NPI:1801039508
Name:HJ SURGERY CENTER INCORPORATED
Entity Type:Organization
Organization Name:HJ SURGERY CENTER INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:H
Authorized Official - Middle Name:DARIEN
Authorized Official - Last Name:BEHRAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:510-614-9200
Mailing Address - Street 1:13690 E 14TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2582
Mailing Address - Country:US
Mailing Address - Phone:510-614-9200
Mailing Address - Fax:510-614-9203
Practice Address - Street 1:13690 E 14TH ST
Practice Address - Street 2:STE 200
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2582
Practice Address - Country:US
Practice Address - Phone:510-614-9200
Practice Address - Fax:510-614-9203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical