# BLUE WAVE SURGERY CENTER, INC.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BLUE WAVE SURGERY CENTER, INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1821362443
- **Legal business name:** BLUE WAVE SURGERY CENTER, INC
- **Authorized official:** DR. ALEXANDER SOROKURS M.D. (PRESIDENT)
- **Authorized official phone:** (310) 622-5369

## Contact information

- **Practice address:** 4910 VAN NUYS BLVD STE 306, SHERMAN OAKS, CA 91403-1770
- **Practice address phone:** (310) 622-5369
- **Mailing address:** 4910 VAN NUYS BLVD STE 306, SHERMAN OAKS, CA 91403-1770
- **Mailing address phone:** (310) 622-5369

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | A54193 | CA | — |
| 261QA1903X | Ambulatory Surgical Clinic/Center | A54193 | CA | Yes |

## Other

- **Enumeration date:** 02/29/2012
- **Last updated:** 04/17/2012