Organization
IRVINE SURGICAL MEDICAL GROUP CORP
Active
Other names
IRVINE ENDOSCOPY AND SURGICAL INSTITUTE
Organization subpart
No
Provider details
NPI number
Authorized official
ARDALAN BABAKNIA PHD,M.D. (CHIEF MEDICAL DIRECTOR AND FINANCIA)
(949) 753-8844
Entity
Organization
Contact information
Practice address
15825 LAGUNA CANYON RD, SUITE 100, IRVINE, CA 92618-2125
(949) 679-6700
(949) 387-9530
Mailing address
15825 LAGUNA CANYON RD, SUITE 100, IRVINE, CA 92618-2125
(949) 679-6700
(949) 387-9530
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
550000008
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D1025785
CLIA
CA
01
—
550000008
DHS STATE LICENSE
CA
05
—
SUR01683F
—
CA
Enumeration date
10/12/2006
Last updated
05/15/2008
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