1386969384 NPI number — JEUNEDERM COSMETIC SURGERY CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386969384 NPI number — JEUNEDERM COSMETIC SURGERY CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEUNEDERM COSMETIC SURGERY CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386969384
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
991 MONTAGUE EXPRESS WAY
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
MILPITAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-263-2223
Provider Business Mailing Address Fax Number:
408-263-2225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
991 MONTAGUE EXPY
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
MILPITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95035-6809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-263-2223
Provider Business Practice Location Address Fax Number:
408-263-2225
Provider Enumeration Date:
04/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
TABRIZ
Authorized Official First Name:
ABDOLREZA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
408-263-2223

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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