Healthcare Provider Details

I. General information

NPI: 1386969384
Provider Name (Legal Business Name): JEUNEDERM COSMETIC SURGERY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 MONTAGUE EXPY SUITE 202
MILPITAS CA
95035-6809
US

IV. Provider business mailing address

991 MONTAGUE EXPRESS WAY SUITE 202
MILPITAS CA
95035
US

V. Phone/Fax

Practice location:
  • Phone: 408-263-2223
  • Fax: 408-263-2225
Mailing address:
  • Phone: 408-263-2223
  • Fax: 408-263-2225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ABDOLREZA TABRIZ
Title or Position: CEO
Credential: MD
Phone: 408-263-2223