Provider Demographics
NPI:1912542994
Name:REPRODUCTIVE MEDICINE ASSOCIATES OF SOCAL AMBULATORY SURGERY CENTER
Entity Type:Organization
Organization Name:REPRODUCTIVE MEDICINE ASSOCIATES OF SOCAL AMBULATORY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:424-293-8841
Mailing Address - Street 1:11500 W OLYMPIC BLVD, STE# 150
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064
Mailing Address - Country:US
Mailing Address - Phone:424-293-8841
Mailing Address - Fax:424-293-8138
Practice Address - Street 1:11500 W OLYMPIC BLVD, STE# 150
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064
Practice Address - Country:US
Practice Address - Phone:424-293-8841
Practice Address - Fax:424-293-8138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical