Provider Demographics
NPI:1750712667
Name:SEA SURGERY CENTER, LLC
Entity type:Organization
Organization Name:SEA SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOHET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-352-8396
Mailing Address - Street 1:770 PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6215
Mailing Address - Country:US
Mailing Address - Phone:562-352-8396
Mailing Address - Fax:562-217-4499
Practice Address - Street 1:770 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6215
Practice Address - Country:US
Practice Address - Phone:562-352-8396
Practice Address - Fax:562-217-4499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical