Healthcare Provider Details

I. General information

NPI: 1154434983
Provider Name (Legal Business Name): AESTHETIC EYE PLASTIC SURGEONS MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16661 VENTURA BLVD STE 826
ENCINO CA
91436-4803
US

IV. Provider business mailing address

16661 VENTURA BLVD STE 826
ENCINO CA
91436-4803
US

V. Phone/Fax

Practice location:
  • Phone: 818-477-0560
  • Fax: 408-724-6592
Mailing address:
  • Phone: 818-477-0560
  • Fax: 408-724-6592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: SANGEETA LOGANI
Title or Position: PRESIDENT
Credential: MD
Phone: 818-477-0560