Provider Demographics
NPI:1922286855
Name:KIOWA ENTERPRISES, LLC
Entity Type:Organization
Organization Name:KIOWA ENTERPRISES, LLC
Other - Org Name:SOUTH BAY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-374-4176
Mailing Address - Street 1:555 PIER AVE
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3839
Mailing Address - Country:US
Mailing Address - Phone:310-374-4176
Mailing Address - Fax:310-374-4175
Practice Address - Street 1:555 PIER AVE
Practice Address - Street 2:SUITE 1-A
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-3839
Practice Address - Country:US
Practice Address - Phone:310-374-4176
Practice Address - Fax:310-374-4175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical