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General NPI Number Information
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NPI Number | 1114246907
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Entity Type | Organization
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Legal Business Name | BELLAVITA CENTER FOR PLASTIC AND RECONSTRUCTIVE SURGERY, CORP.
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Dates
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Enumeration Date | 05/19/2010
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Last Update Date | 11/19/2012
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Provider Practice Location Address
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Address Line | 416 N BEDFORD DR STE 100
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4308
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Country | US
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Telephone | 310-275-1114
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Fax | 310-275-1157
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Provider Business Mailing Address
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Address Line | 416 N BEDFORD DR STE 100
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4308
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Country | US
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Telephone | 310-275-1114
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Fax | 310-275-1157
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN FU-TSUN HSU
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Credential | DO
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Telephone | 310-275-1114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 20A11134
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License Number State | CA
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