Healthcare Provider Details

I. General information

NPI: 1861685331
Provider Name (Legal Business Name): BEVERLY AESTHETIC SURGERY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2007
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 N LA CIENEGA BLVD SUITE 302
BEVERLY HILLS CA
90211-2222
US

IV. Provider business mailing address

99 N LA CIENEGA BLVD SUITE 302
BEVERLY HILLS CA
90211-2222
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-6759
  • Fax: 310-360-7970
Mailing address:
  • Phone: 310-659-6759
  • Fax: 310-360-7970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA60220
License Number StateCA

VIII. Authorized Official

Name: DENNIS BANG
Title or Position: CEO/PHYSICIAN
Credential: M.D.
Phone: 310-659-6759