Healthcare Provider Details

I. General information

NPI: 1679805675
Provider Name (Legal Business Name): G S TAKOWSKY PLASTIC SURGERY GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 WILSHIRE BLVD STE. 630
BEVERLY HILLS CA
90211-3121
US

IV. Provider business mailing address

8500 WILSHIRE BLVD STE. 630
BEVERLY HILLS CA
90211-3121
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-7741
  • Fax:
Mailing address:
  • Phone: 310-657-7741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. GARY S TAKOWSKY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-657-7741