Healthcare Provider Details

I. General information

NPI: 1699708867
Provider Name (Legal Business Name): PLASTIC & RECONSTRUCTIVE SURGERY OF CHESTER COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 CREAMERY WAY SUITE 110
EXTON PA
19341-2533
US

IV. Provider business mailing address

460 CREAMERY WAY SUITE 110
EXTON PA
19341-2533
US

V. Phone/Fax

Practice location:
  • Phone: 610-524-8244
  • Fax: 610-524-1182
Mailing address:
  • Phone: 610-524-8244
  • Fax: 610-524-1182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DAVID KIM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 610-524-8244