Healthcare Provider Details

I. General information

NPI: 1255923595
Provider Name (Legal Business Name): MODERN AESTHETIC INSTITUTE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 TRUXTUN AVE STE 200
BAKERSFIELD CA
93309-0743
US

IV. Provider business mailing address

PO BOX 2029
BAKERSFIELD CA
93303-2029
US

V. Phone/Fax

Practice location:
  • Phone: 805-565-5700
  • Fax:
Mailing address:
  • Phone: 805-565-5700
  • Fax: 661-335-7766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH H CHANG
Title or Position: PRESIDENT
Credential: MD
Phone: 805-565-5700