Provider Demographics
NPI:1902246366
Name:DIABETIC FOOT SURGEONS OF CALIFORNIA INC
Entity Type:Organization
Organization Name:DIABETIC FOOT SURGEONS OF CALIFORNIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-517-4736
Mailing Address - Street 1:1800 S PACIFIC COAST HWY UNIT 28
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-6161
Mailing Address - Country:US
Mailing Address - Phone:310-517-4736
Mailing Address - Fax:310-784-8763
Practice Address - Street 1:3330 LOMITA BLVD
Practice Address - Street 2:WEST TOWER 5TH FLOOR
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-517-4736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-01
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty