Healthcare Provider Details

I. General information

NPI: 1922864743
Provider Name (Legal Business Name): SF BAY AREA PLASTIC SURGERY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 SOUTH DR STE 25
MOUNTAIN VIEW CA
94040-4209
US

IV. Provider business mailing address

515 SOUTH DR STE 25
MOUNTAIN VIEW CA
94040-4209
US

V. Phone/Fax

Practice location:
  • Phone: 650-964-2200
  • Fax: 650-964-2205
Mailing address:
  • Phone: 650-964-2200
  • Fax: 650-964-2205

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: DR. SHAHIN FAZILAT
Title or Position: OWNER
Credential: MD
Phone: 650-964-2200