Provider Demographics
NPI:1952355422
Name:BENEFIT SURGERY MEDICAL CENTER
Entity Type:Organization
Organization Name:BENEFIT SURGERY MEDICAL CENTER
Other - Org Name:BENEFIT SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YONG
Authorized Official - Middle Name:TAI
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-989-4100
Mailing Address - Street 1:9674 ARCHIBALD AVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730
Mailing Address - Country:US
Mailing Address - Phone:909-989-4100
Mailing Address - Fax:909-989-5400
Practice Address - Street 1:9674 ARCHIBALD AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:909-989-4100
Practice Address - Fax:909-989-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000845261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA240000845OtherSURG. CLINIC LICENSE DHS
ZZZ27189ZMedicare PIN
Y00037Medicare UPIN
CA240000845OtherSURG. CLINIC LICENSE DHS