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General NPI Number Information
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NPI Number | 1619157294
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Entity Type | Organization
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Legal Business Name | GRAND STRAND PLASTIC & RECONSTRUCTIVE SURGERY CENTER PA
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Dates
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Enumeration Date | 11/12/2007
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Last Update Date | 03/02/2025
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Provider Practice Location Address
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Address Line | 4610 OLEANDER DR SUITE 101
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City | MYRTLE BEACH
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State | SC
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Zip | 29577-5752
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Country | US
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Telephone | 843-497-2227
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Fax | 843-449-9265
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Provider Business Mailing Address
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Address Line | 4610 OLEANDER DR SUITE 101
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City | MYRTLE BEACH
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State | SC
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Zip | 29577-5752
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Country | US
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Telephone | 843-497-2227
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Fax | 843-449-9265
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KIMBERLEY B GOH
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Credential | MD
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Telephone | 843-497-2227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 15346
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License Number State | SC
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