Provider Demographics
NPI:1730583808
Name:90210 SURGICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:90210 SURGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-274-2763
Mailing Address - Street 1:465 N ROXBURY DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4206
Mailing Address - Country:US
Mailing Address - Phone:310-274-2763
Mailing Address - Fax:424-239-5086
Practice Address - Street 1:465 N ROXBURY DR
Practice Address - Street 2:SUITE 1020
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4206
Practice Address - Country:US
Practice Address - Phone:310-274-2763
Practice Address - Fax:424-239-5086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical