Healthcare Provider Details

I. General information

NPI: 1326994302
Provider Name (Legal Business Name): CALIFORNIA ADVANCED AESTHETIC & RECONTRUCTIVE SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W COLLEGE ST STE 560
LOS ANGELES CA
90012-1285
US

IV. Provider business mailing address

711 W COLLEGE ST STE 560
LOS ANGELES CA
90012-1285
US

V. Phone/Fax

Practice location:
  • Phone: 213-628-3592
  • Fax: 213-628-3593
Mailing address:
  • Phone: 213-628-3592
  • Fax: 213-628-3593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL K MCLEAN
Title or Position: PRESIDENT
Credential: MD
Phone: 213-628-3592