=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295983450
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMOOTH AESTHETICS INC, A MEDICAL CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2008
-----------------------------------------------------
Last Update Date | 08/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1510 W VERDUGO AVE STE E
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91506-2472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-954-0510
-----------------------------------------------------
Fax | 818-954-0419
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1510 W VERDUGO AVE STE E
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91506-2472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-954-0510
-----------------------------------------------------
Fax | 818-954-0419
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE-PRES
-----------------------------------------------------
Name | MARGARET H FINK
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 818-954-0510
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC29743
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A78999
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A78697
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------