Provider Demographics
NPI:1144708850
Name:GLENDALE SURGICAL ASSOCIATES
Entity type:Organization
Organization Name:GLENDALE SURGICAL ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:206-356-0449
Mailing Address - Street 1:550 W DUARTE RD
Mailing Address - Street 2:SUITE #7
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007
Mailing Address - Country:US
Mailing Address - Phone:626-446-0728
Mailing Address - Fax:
Practice Address - Street 1:550 W DUARTE RD
Practice Address - Street 2:SUITE 7
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007
Practice Address - Country:US
Practice Address - Phone:626-446-0728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLENDALE SURGICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty