Healthcare Provider Details

I. General information

NPI: 1801138946
Provider Name (Legal Business Name): SKY FACIAL PLASTIC SURGERY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16918 DOVE CANYON RD SUITE 208
SAN DIEGO CA
92127-3445
US

IV. Provider business mailing address

16918 DOVE CANYON RD SUITE 208
SAN DIEGO CA
92127-3445
US

V. Phone/Fax

Practice location:
  • Phone: 858-381-4801
  • Fax:
Mailing address:
  • Phone: 858-381-4801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SIRIUS K YOO
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 858-381-4801