Healthcare Provider Details

I. General information

NPI: 1962332213
Provider Name (Legal Business Name): 5 STAR AESTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 W GRANGEVILLE BLVD STE A
HANFORD CA
93230-2858
US

IV. Provider business mailing address

560 W GRANGEVILLE BLVD STE A
HANFORD CA
93230-2858
US

V. Phone/Fax

Practice location:
  • Phone: 559-408-5533
  • Fax: 800-827-1977
Mailing address:
  • Phone: 559-408-5533
  • Fax: 800-827-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MANIVANH BAUM
Title or Position: OWNER
Credential:
Phone: 559-408-5533