Provider Demographics
NPI:1821572033
Name:IRVINE SPECIALTY CARE SURGERY CENTER
Entity Type:Organization
Organization Name:IRVINE SPECIALTY CARE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHURAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SIAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-416-1070
Mailing Address - Street 1:31569 CANYON ESTATES DR STE 135
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-0472
Mailing Address - Country:US
Mailing Address - Phone:951-734-7246
Mailing Address - Fax:951-674-7244
Practice Address - Street 1:4968 BOOTH CIR STE 105
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3366
Practice Address - Country:US
Practice Address - Phone:951-734-7246
Practice Address - Fax:951-674-7244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty