Provider Demographics
NPI:1972025948
Name:SILICON BEACH SURGERY CENTER INC
Entity Type:Organization
Organization Name:SILICON BEACH SURGERY CENTER INC
Other - Org Name:SILICON BEACH SURGERY CENTER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:SUN
Authorized Official - Last Name:YI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-305-9200
Mailing Address - Street 1:13428 MAXELLA AVE # 527
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5620
Mailing Address - Country:US
Mailing Address - Phone:310-305-9200
Mailing Address - Fax:310-305-2800
Practice Address - Street 1:5450 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:PLAYA VISTA
Practice Address - State:CA
Practice Address - Zip Code:90094-2002
Practice Address - Country:US
Practice Address - Phone:310-305-9200
Practice Address - Fax:310-305-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical