Healthcare Provider Details

I. General information

NPI: 1487588315
Provider Name (Legal Business Name): DR JASON PLASTIC SURGERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9675 BRIGHTON WAY STE 350
BEVERLY HILLS CA
90210-5188
US

IV. Provider business mailing address

9675 BRIGHTON WAY STE 350
BEVERLY HILLS CA
90210-5188
US

V. Phone/Fax

Practice location:
  • Phone: 909-710-2020
  • Fax: 909-710-2021
Mailing address:
  • Phone: 909-710-2020
  • Fax: 909-710-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVUNI KAY HARRISON
Title or Position: BILLING ADMINISTRATOR
Credential:
Phone: 909-710-2020