Provider Demographics
NPI:1275522849
Name:COLIMA ENDOSCOPY CENTER INC
Entity type:Organization
Organization Name:COLIMA ENDOSCOPY CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNG
Authorized Official - Middle Name:JUN
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-913-1116
Mailing Address - Street 1:1900 S BREA CANYON RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4059
Mailing Address - Country:US
Mailing Address - Phone:626-913-1116
Mailing Address - Fax:626-913-1261
Practice Address - Street 1:1900 S BREA CANYON RD UNIT A
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4059
Practice Address - Country:US
Practice Address - Phone:626-913-1116
Practice Address - Fax:626-913-1261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05C0001387261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01387FMedicaid
CA05C0001387OtherMEDICARE AMBULATORY SURGICAL CENTER CERTIFICATION
CASUR01387FMedicaid