Healthcare Provider Details

I. General information

NPI: 1366362824
Provider Name (Legal Business Name): LOTUS ESTHETIC MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 CALLAN AVE STE 301
SAN LEANDRO CA
94577-4641
US

IV. Provider business mailing address

433 CALLAN AVE STE 301
SAN LEANDRO CA
94577-4641
US

V. Phone/Fax

Practice location:
  • Phone: 415-848-9076
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES OTIS HILL
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 341-258-2050