Healthcare Provider Details

I. General information

NPI: 1669515862
Provider Name (Legal Business Name): KANIFF COSMETIC MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 FULTON AVE
SACRAMENTO CA
95825-4813
US

IV. Provider business mailing address

631 FULTON AVE
SACRAMENTO CA
95825-4813
US

V. Phone/Fax

Practice location:
  • Phone: 916-480-9080
  • Fax: 916-480-9411
Mailing address:
  • Phone: 916-480-9080
  • Fax: 916-480-9411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS E KANIFF
Title or Position: PRESIDENT
Credential: M.D.
Phone: 916-480-9080