Provider Demographics
NPI:1851625990
Name:ADVANCED SURGICAL SOLUTIONS, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ADVANCED SURGICAL SOLUTIONS, A MEDICAL CORPORATION
Other - Org Name:ADVANCED SURGICAL SOLUTIONS, AMC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KASHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-804-5177
Mailing Address - Street 1:865 COMSTOCK AVE
Mailing Address - Street 2:STE 4D
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-2572
Mailing Address - Country:US
Mailing Address - Phone:818-804-5177
Mailing Address - Fax:818-787-8249
Practice Address - Street 1:16133 VENTURA BLVD
Practice Address - Street 2:STE 415
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2403
Practice Address - Country:US
Practice Address - Phone:818-804-5177
Practice Address - Fax:818-787-8249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87624208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1851625990OtherGROUP NPI
CAFK0030407OtherDEA