Healthcare Provider Details

I. General information

NPI: 1003231366
Provider Name (Legal Business Name): PLASTIC SURGEONS INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 12/28/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HOSPITAL DR BLDG 9
MOUNTAIN VIEW CA
94040-4106
US

IV. Provider business mailing address

2500 HOSPITAL DR BLDG 9
MOUNTAIN VIEW CA
94040-4106
US

V. Phone/Fax

Practice location:
  • Phone: 650-254-1200
  • Fax: 650-254-1226
Mailing address:
  • Phone: 650-254-1200
  • Fax: 650-254-1226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA KORMAN
Title or Position: OWNER
Credential: MD
Phone: 650-254-1200