Healthcare Provider Details

I. General information

NPI: 1568780237
Provider Name (Legal Business Name): DR. K PLASTIC SURGERY, A MEDICAL CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11160 WARNER AVE STE 119
FOUNTAIN VALLEY CA
92708-4010
US

IV. Provider business mailing address

11160 WARNER AVE STE 119
FOUNTAIN VALLEY CA
92708-4010
US

V. Phone/Fax

Practice location:
  • Phone: 714-444-4495
  • Fax: 714-444-4498
Mailing address:
  • Phone: 714-444-4495
  • Fax: 714-444-4498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License NumberG87295
License Number StateCA

VIII. Authorized Official

Name: DR. BEHROOZ KALANTARIAN
Title or Position: PLASTIC SURGEON
Credential:
Phone: 310-650-2073