Healthcare Provider Details

I. General information

NPI: 1952259087
Provider Name (Legal Business Name): WINK AESTHETIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 N WHISMAN RD STE 200
MOUNTAIN VIEW CA
94043-5721
US

IV. Provider business mailing address

455 N WHISMAN RD STE 200
MOUNTAIN VIEW CA
94043-5721
US

V. Phone/Fax

Practice location:
  • Phone: 650-963-9115
  • Fax:
Mailing address:
  • Phone: 650-963-9115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN ROME
Title or Position: PRESIDENT
Credential: MD
Phone: 510-827-3377