Healthcare Provider Details

I. General information

NPI: 1780514463
Provider Name (Legal Business Name): KM FACIAL PLASTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4789 BLOSSOM DR
DELRAY BEACH FL
33445-5323
US

IV. Provider business mailing address

4789 BLOSSOM DR
DELRAY BEACH FL
33445-5323
US

V. Phone/Fax

Practice location:
  • Phone: 561-200-5095
  • Fax:
Mailing address:
  • Phone: 561-200-5095
  • 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: DR. JACLYN KLIMCZAK
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 561-200-5095