Healthcare Provider Details

I. General information

NPI: 1982828554
Provider Name (Legal Business Name): HEAD& NECK MEDICAL & FACIAL PLASTIC SURGERY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 HOSPITAL ROAD SUITE 329
NEWPORT BEACH CA
92663-3524
US

IV. Provider business mailing address

361 HOSPITAL RD SUITE 329
NEWPORT BEACH CA
92663-3522
US

V. Phone/Fax

Practice location:
  • Phone: 949-650-8882
  • Fax: 949-650-2293
Mailing address:
  • Phone: 949-650-8882
  • Fax: 949-650-2293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA89307
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA25477
License Number StateCA

VIII. Authorized Official

Name: KAMAL A. BATNIJI
Title or Position: OWNER
Credential: M.D.
Phone: 949-650-8882